Endoscopy 2012; 44(04): 349-353
DOI: 10.1055/s-0031-1291657
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Incontinence after colonoscopy – an unrecognized and preventable problem. A cross-sectional study from the Gastronet quality assurance program

G. Hoff
1   Department of Medicine, Telemark Hospital, 3710 Skien, Norway
2   Cancer Registry of Norway, 0304 Oslo, Norway
3   University of Oslo, 0027 Oslo, Norway
,
V. Moritz
1   Department of Medicine, Telemark Hospital, 3710 Skien, Norway
,
M. Bretthauer
2   Cancer Registry of Norway, 0304 Oslo, Norway
,
L. Aabakken
4   Department of Medicine, Rikshospitalet, University of Oslo, 0027 Oslo, Norway
,
I. P. Berset
5   Department of Medicine, Aalesund Hospital, 6022 Aalesund, Norway
,
T. Glomsaker
6   Department of Surgery, Stavanger University Hospital, 4068 Stavanger, Norway
,
O. Høie
7   Department of Medicine, Sørlandet Hospital Arendal, 4809 Arendal, Norway
,
T. de Lange
8   Department of Medicine, Bærum Hospital Vestre Viken HF, 1309 Rud, Norway
,
on behalf of the Gastronet collaborators› Author Affiliations
Further Information

Publication History

submitted 19 June 2011

accepted after revision 09 December 2011

Publication Date:
05 March 2012 (online)

Preview

Background: Colonoscopy requires insufflation of gas for visualization of the bowel wall. Worldwide, this is usually done using air. The aim of the present study was to assess the risk of postcolonoscopy incontinence, and to investigate whether insufflation of CO2 instead of air may reduce this risk, since it is easily absorbed through the bowel mucosa.

Methods: This is a prospective multicenter study of colonoscopy patients undergoing bowel insufflation using air or CO2. A successive series of colonoscopies were reported to a national quality assurance program in Norway between January and December 2009 from 21 endoscopy centers with varying insufflation practices. The study comprised 7812 patients aged 18 years or older who were referred for outpatient colonoscopy. Of these, 5015 underwent colonoscopy performed using air and 2797 colonoscopy using CO2 insufflation.

Results: Patient-reported incontinence up to 24 h after colonoscopy was compared using binary logistic regression analysis for the type of gas used for insufflation. The air and CO2 patient groups were comparable with regard to age, sex, indication for colonoscopy, and sedation practice. Incontinence was reported by 336 out of 7812 patients (4.3 %). Incontinence was significantly less frequent in the CO2 group than in the air group [2.1 % versus 5.5 %; adjusted odds ratio (OR) 0.38; 95 %CI 0.28 – 0.50; P < 0.001]. Female patients had a higher risk of incontinence than men (adjusted OR 1.77; 95 % CI 1.39 – 2.24; P < 0.001).

Conclusion: About every 20th patient undergoing colonoscopy using standard air insufflation experiences postexamination incontinence. This proportion can be reduced by 60 % by converting from air insufflation to insufflation with the absorbable CO2.