CO2- vs. Luft-Insufflation bei der Doppelballon-Enteroskopie – Eine randomisierte kontrollierte Doppelblind-Studie

Background: Double balloon enteroscopy (DBE) has been proven effective for deep intubation of the small bowel. However, intubation depth is limited by distension of the small bowel due to air insufflation during the procedure. The present trial investigates whether carbon dioxide (CO2) instead of standard air insufflation would improve intubation depth during DBE, as well as reduce post-procedure pain.

Patients and methods: 112 consecutive patients scheduled for DBE at two centres were randomly assigned to either CO2 or air insufflation. Patients and endoscopists were blinded with regard to the type of gas used. Intubation depth was registered using a validated form. Patients scored pain and discomfort during and after the examination on visual analogue scale.

Results: 100 patients were eligible for data analyses. The mean small bowel intubation depth was extended by 30% in the CO2 group compared to the air group (230 vs. 177cm, p=0.008). The superiority was even more pronounced for oral DBEs, with a 71cm improvement of intubation depth when using CO2 (295cm in CO2 group vs. 224cm in air group, p<0.001). Patient pain and discomfort was significantly reduced in the CO2 group at one and three hour after the examination.

Conclusions: CO2 insufflation significantly improves intubation depth and patient discomfort during DBE. Thus, CO2 insufflation may lead to a higher diagnostic and therapeutic yield of DBE, with reduced patient discomfort.

Keywords: double balloon enteroscopy, carbon dioxide, air, small bowel, intubation depth