比较注水肠镜与传统注气肠镜检查对老年患者结肠息肉检出率的影响

目的比较注水肠镜与传统注气肠镜检查对老年患者结肠息肉检出率的影响,探讨注水肠镜的优势。方法选择因下消化道症状就诊并行非麻醉肠镜的老年患者102例,随机分为注水肠镜组(A组)53例和注气肠镜组(B组)49例,比较患者结直肠息肉检出率、疼痛评分、肠镜达盲肠时间、插镜深度、全结肠检查率、进镜与退镜时肠道清洁度、操作者主观难易度及相关并发症等。结果注水肠镜组患者结肠息肉检出率显著高于注气肠镜组(P=0.021);术中腹痛评分明显低于注气肠镜组(P=0.001);注水肠镜组患者的退镜清洁度评分高于注气肠镜组(P=0.030);插镜深度明显小于注气肠镜组(P=0.003);注水肠镜组操作者主观评价得分显著高于注气肠镜组(P=0.007)。结论注水肠镜显著提高了老年患者的结直肠息肉检出率,减轻了老年患者肠镜检查中的腹部疼痛与不适感,操作更为简便,同时显著提高了退镜时的肠道清洁度。     

注水与注气在结肠镜进镜过程中的随机对照研究

目的 比较注水进镜与空气注气进镜在肠镜操作中对受检者耐受性的影响。方法单中心单盲随机对照临床研究。受检者随机分入3组：空气注气进镜组,单纯注水进镜组,注水注气结合进镜组。观察指标：进镜时间、全结肠检查率、腺瘤检出率、体位变换率、腹壁按压率、术中术后腹痛腹胀评分。结果入组病例共计180例,每组60例。单纯注水进镜以及注水注气结合进镜与空气注气进镜相比,进镜时间更长,较少腹壁按压与体位变化,术中腹痛腹胀较轻。3组在全结肠检查率、腺瘤检出率、术后腹痛腹胀程度并无差异。结论注水进镜能够显著缓解受检者术中腹痛腹胀不适,且不影响全结肠检查率、腺瘤检出率。     

注水法在婴幼儿结肠镜检查中的应用

目的比较注气法和注水法在婴幼儿结肠镜检查中的达盲时间、麻醉药物剂量等，探索注水法结肠镜检查在婴幼儿中的应用价值。 方法收集2019年1月至2020年9月经吉林大学第一医院小儿消化科行无痛结肠镜检查的71例患儿，年龄为月龄≤72个月，其中，观察组为注水法35例，对照组为同期行传统注气法36例。应用SPSS统计学软件分析比较两组患者的达盲率、达盲时间、达盲时丙泊酚用量等差异，并探讨注水法中注水量的影响因素。 结果观察组的达盲率为100%，对照组的达盲率为94.4%，差异无统计学意义；观察组的达盲时间(8.66±4.20)min，显著少于对照组达盲时间(16.69±9.22)min(P<0.05)；观察组达盲时丙泊酚用量(64.00±18.50)mg显著少于对照组丙泊酚用量(83.33±25.72)mg(P<0.05)。对注水法结肠镜注水量的相关因素分析中，发现肠道准备程度与注水量之间具有显著相关性(P<0.05)。 结论注水法在婴幼儿结肠镜中安全、可靠，适合在临床推广、应用。     

注水结肠镜与注气结肠镜检查240例临床对照研究

目的探讨注气结肠镜与注水结肠镜检查的舒适度及操作性。方法选取2016年6-9月在北部战区总医院内窥镜科接受结肠镜检查的240例患者,将其随机分为注气结肠镜检查组和注水结肠镜检查组,比较两组患者一般情况,记录检查的达盲率、时间、腹痛评分,随访腹痛、腹胀及再次检查是否选择无痛结肠镜意愿。结果注气组与注水组在一般情况、进镜成功率、进镜深度、检查后腹痛情况、再次检查选择无痛结肠镜等方面差异无统计学意义(P0.05);注气组疼痛评分明显高于注水组(P=0.001),注水组的进镜时间、退镜时间及操作总时间明显高于注气组(P0.001,P=0.013,P0.001),检查后1 h腹胀程度注气组明显高于注水组(P0.001),检查后6 h腹胀程度两组间差异无统计学意义(P0.05)。结论注水结肠镜检查可明显减轻患者腹痛和检查后腹胀不适感,但其操作时间较注气法延长。     

注水结肠镜检查对老年患者腹痛和炎症反应的影响

背景:老年患者行结肠镜检査的难度相对较大,检查过程中腹痛和组织损伤的发生率增加。目的:探讨注水结肠镜检查对老年患者腹痛和炎症反应的影响。方法:纳入2014年1月—2016年6月在南阳市第二人民医院择期接受结肠镜检查的老年患者40例,随机分入注水结肠镜检查组(注水组)和常规结肠镜检查组(注气组)。记录两组进镜、退镜时间,以视觉模拟评分法(VAS)评估腹痛程度,以ELISA法检测检查前后血清炎症反应指标肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平。结果:注水组检查过程中的腹痛VAS评分显著低于注气组(P0.05),两组间进镜、退镜时间则无明显差异(P0.05)。检查前,两组间各血清炎症反应指标差异均无统计学意义(P0.05);检查结束即刻以及检查后6 h和24 h,注气组血清TNF-α、IL-6、CRP水平均显著高于检查前(P0.05),且高于同时间点注水组(P0.05)。注水组炎症反应指标的恢复快于注气组。结论:注水结肠镜检查可减轻老年患者检查过程中的腹痛感受,同时有效抑制机体炎症反应。     

注水法行结肠镜检查在便秘患者中的应用

背景:内镜医师普遍认为便秘患者行结肠镜检查的操作难度较非便秘患者相对增加。目的:分析注水法行结肠镜检查在便秘患者中的效果。方法:选择2010年11月~2011年11月江苏省苏北人民医院便秘患者200例,随机分为注水组和注气组。比较两组进镜时间、退镜时间、疼痛程度、满意度以及操作过程中是否需外界辅助。结果:与注气组相比,注水组患者平均进镜时间、退镜时间均无明显差异,疼痛程度明显降低(3.5±2.3对9.5±4.3,P0.05),满意率显著升高(90.8%对17.6%,P0.05),需外界辅助的发生率明显降低(体位变化:33.7%对73.5%、腹部压迫:16.3%对62.7%、调节镜身硬度:8.2%对21.6%,P0.05)。结论:对于便秘患者,注水法行结肠镜检查可明显减轻患者的疼痛不适,对顺利完成结肠镜检查有切实可行的应用价值。     

二氧化碳注入联合水交换在肠镜检查中的应用效果分析

目的探究二氧化碳注入联合水交换在肠镜检查中的应用效果。方法选择2018年2至11月新疆军区总医院北京路临床部拟行结肠镜检查的患者190例,随机分为空气组(63例)、水交换组(63例)和联合组(64例)。空气组患者采用常规注气结肠镜检查;水交换组患者采用注水结肠镜检查;联合组患者采用二氧化碳气泵联合注水结肠镜检查。比较三组的结肠镜检查情况、检查后不适症状间的差异。结果水交换组和联合组的退镜时间和麻醉需求率均显著低于空气组,两组的盲插成功率和Boston评分均明显高于空气组(P 0. 05);联合组的退镜时间明显低于水交换组,差异均有统计学意义(P 0. 05)。三组的进镜时间和检出率间均无统计学差异(P0. 05)。水交换组、联合组检查中及检查后1 h的VAS评分和腹胀评分显著低于空气组(P 0. 05)。检查中,联合组的VAS评分低于水交换组(P 0. 05),两组的腹胀评分比较无统计学差异(P 0. 05);检查后1 h,联合组的VAS评分和腹胀评分均显著低于水交换组(P 0. 05)。结论二氧化碳注入联合水交换可明显减少退镜时间和麻醉需求,有效改善清洁度,减轻患者的疼痛和腹胀程度。     

气囊辅助式小肠镜对小肠疾病诊疗分析

目的 探讨气囊辅助式小肠镜（以下简称“小肠镜”）在小肠疾病诊疗中的有效性及安全性。方法 回顾性分析2005年11月至2019年10月在南昌大学第一附属医院接受小肠镜诊疗患者的临床、内镜及病理资料。结果 最常见的小肠镜阳性诊断为非特异性肠炎（14.4%）、克罗恩病（9.9%）和小肠肿瘤（8.6%）。非特异性肠炎、克罗恩病、梅克尔憩室的检出率男性高于女性，血管畸形的检出率女性高于男性；克罗恩病、梅克尔憩室检出率青年患者较高，小肠肿瘤、血管畸形检出率老年患者较高；接受小肠镜检查的患者最常见临床表现是腹痛（42.0%）和不明原因消化道出血（OGIB）(32.9%),OGIB患者的小肠疾病检出率显著高于腹痛患者（67.6%比36.7%,P<0.001）。小肠镜诊疗操作并发症发生率为0.6%。结论 气囊辅助式小肠镜是一种有效且安全的小肠疾病诊疗方法。     

丙泊酚-瑞芬太尼靶控输注在老年患者肠镜检查中的临床应用探讨

目的研究丙泊酚-瑞芬太尼靶控输注用于老年患者无痛肠镜检查的安全性、有效性及可行性。方法将67例门诊及住院需要肠镜检查的老年患者随机分为A组（34例）及B组（33例）；A组采用丙泊酚-瑞芬太尼靶控输注，丙泊酚血浆靶控浓度为0．5～1．0μg／ml、瑞芬太尼血浆靶控浓度0．5～1．0ng／ml同时靶控输注：B组常规操作。RamsayⅡ级开始插镜，抵达回盲部停止给药。分别记录术前、进镜至回盲部及检查完毕SBP、DBP、HR、Sp02值及不良反应发生的例数。结果Ramsay评分A组Ⅱ级97．1％，B组Ⅰ级100％（P〈0．01）；进镜至回盲部过程：A组SBP、DBP、HR无明显变化，B组明显高于术前，与A组有显著性差异（P〈0．05）；A组体动及呻吟明显少于B组（P〈0．01）；A组操作成功率及患者满意度明显高于B组（P〈0．01）：A组无呼吸抑制发生。结论老年患者应用丙泊酚-瑞芬太尼靶控输注麻醉效果好，血流动力学稳定，肠镜操作成功率高，患者的耐受性好，是一种安全、有效、可行的无痛肠镜麻醉方法。     

无痛肠镜与常规肠镜检查的前瞻性对照研究

目的探讨无痛肠镜和常规肠镜检查在临床工作中的选择。方法362例自愿接受无痛肠镜检查患者（无痛肠镜组）和323例自愿接受常规肠镜检查患者（常规肠镜组）纳入对照研究,均于检查结束后完成问卷调查,统计分析2组检查完成情况、操作时间、检查费用、不适反应发生情况以及问卷调查结果。结果无痛肠镜组和常规肠镜组检查完成率分别为98．9％（358／362）和89．8％（290／323）（P=0．337）,操作时间分别为（5．60±3．25）min和（7．71±5．70）min（P〈0．001）,平均检查费用分别为人民币886．54元／人和386．00元／人（P〈0．001）,操作相关不适反应总发生率分别为13．3％（48／362）与83．6％（270／323）（P〈0．001）,患者满意度评分分别为4（3-4）分和3（2-3）分（P〈0．001）,操作者满意度评分分别为4（34）和4（4-4）分（P〈0．001）。无痛肠镜组和常规肠镜组愿意再次接受相同检查方式检查的患者数分别为354例（97．79％）和225例（69．66％）（P〈0．001）,常规肠镜组愿意再次接受常规肠镜检查的相关因素分析结果显示男性患者（P=0．035）、无腹部手术史者（P〈0．001）、检查过程中未出现腹痛者（P=0．015）更愿意再次接受常规肠镜检查。结论常规肠镜检查虽然耗时较长,但可避免麻醉风险,且检查所需费用较低,仍是目前国内结直肠疾病检查不可欠缺的重要方法。内镜医师在选择肠镜检查方式时,不仅要考虑患者术中耐受,更要根据患者实际情况严格把握适应证,在充分利用现有医疗资源的前提下使患者得到及时的诊治。     

Water-Related Techniques for Performance of Colonoscopy

Background Passage through difficult colonic segments, cecal intubation rate, time to reach the cecum, procedure-related discomfort, and medication requirement are important outcome measures of a colonoscopic examination. Several techniques of water infusion to aid insertion have been described. Raising awareness of these simple inexpensive methods may help to enhance colonoscopists’ performance. Aim To review water-related methods that facilitated colonoscope insertion. Method A literature search (Medline, PubMed) was conducted using the following terms: sigmoidoscopy, colonoscopy, and water infusion, irrigation, or loading. The effects of water infusion in sedated and unsedated patients are tabulated and discussed. Results Five reports described the use of water infusion in conjunction with usual air insufflation. Enhanced cecal intubation, decreased time to reach the cecum, and attenuated abdominal discomfort were reported. Dose of medication used for sedation was not reduced. The sixth report described a novel method of water infusion in lieu of air insufflation during insertion. When patients accepted sedation on demand, the novel method permitted 52% to complete colonoscopy without sedation. Conclusion Warm water infusion as an adjunct to usual air insufflation enhances colonoscopy outcome. Randomized controlled trials comparing the novel method with usual air insufflation deserve to be considered.     

Limited water infusion decreases pain during minimally sedated colonoscopy

AIM:To investigate a limited water infusion method in colonoscopy.METHODS:Consecutive patients undergoing minimally sedated colonoscopy were randomized to receive air insufflation(n = 89) or water infusion limited to the rectum,sigmoid colon and descending colon(n = 90).Completion rates,cecal intubation times,procedure times,need for abdominal compression,turning of patients and levels of discomfort were evaluated.RESULTS:Completion rates,total procedure times,need for abdominal compression,and turning of p...     

Water intubation method can reduce patients' pain and sedation rate in colonoscopy: A meta‐analysis

Several randomized controlled trials (RCT) have shown that water infusion in lieu of air insufflation reduces sedation rate and pain score and increases cecal intubation rate in colonoscopy. The aim of the present study was to confirm the beneficial effects of the water intubation method over the air method. Electronic databases were searched to identify RCT reporting colonoscopy detection using the water method. The pooled data of sedation rate, pain score and other procedure‐related outcomes were analyzed. Then, 15 full‐text articles were selected and assessed. Nine trials with high‐quality scores were enrolled into this meta‐analysis including a total of 1414 participants. Pooled odds ratio (OR) of sedation rate was 0.392 (95% confidence interval (CI): 0.288–0.533, P = 0.000). Pooled weighted mean difference (WMD) of pain score was ?1.543 (95% CI: ?2.107–?1.069,P = 0.000). Pooled OR of cecal intubation rate was 1.90 (95% CI: 1.29–2.82, P = 0.001). Pooled OR of polyp detection rate and adenoma detection rate were 0.805 (95% CI: 0.606–1.069, P = 0.134) and 0.913 (95% CI: 0.681–1.223, P = 0.168), respectively. Pooled WMD of cecal intubation time was 0.701 (95% CI: ?0.486–1.889, P = 0.247). This meta‐analysis confirmed that the water method significantly reduced sedation rate and degree of pain without decreasing cecal intubation rate and disease detection rate and without requiring more cecal intubation time, suggesting that the novel water method is better than the conventional air method in colonoscopy detection.     

Water infusion versus air insufflation for colonoscopy: a meta-analysis of randomized controlled trials

Background

The aim of this meta-analysis was to determine whether water infusion colonoscopy (WIC) is a more effective diagnostic tool than standard air insufflation colonoscopy (AIC).

Methods

All articles pertinent to a comparison of water-related methods and air insufflation to facilitate insertion of the colonoscope were retrieved from PubMed, Web of Science, Embase, and Cochrane databases. Pooling results were derived by using the Review Manager Software. Outcomes were assessed using the weighted mean difference (MD) with 95 % confidence intervals (CI) for continuous variables and the odds ratios (OR) with 95 % CI for dichotomous variables.

Results

Eighteen studies involving 2,797 patients were included. WIC was associated with a significantly higher cecal intubation rate than AIC (OR = 1.90; 95 % CI 1.21–2.99; p = 0.005). The intubation time was similar for the two types of colonoscopy, but in WIC there was a significantly lower visual analog scale score for abdominal pain than in AIC (MD = ?1.30; 95 % CI ?2.03 to ?0.58; p < 0.001) without sacrificing the polyp detection rate (OR = 1.17; 95 % CI 0.78–1.77; p = 0.44). Statistically, the patient’s willingness to repeat colonoscopy was significantly greater for WIC than for AIC (OR = 1.74; 95 % CI 1.14–2.67; p < 0.01). Furthermore, in the subgroup for trainees, the WIC group achieved a higher cecal intubation rate (OR = 1.83; 95 % CI 1.15–2.93; p = 0.01) and a shorter intubation time (MD = ?1.72 min; 95 % CI ?3.34 to ?0.11; p = 0.04) than the AIC group.

Conclusions

In contrast to AIC, WIC improved cecal intubation, alleviated abdominal pain, and increased patients’ willingness to repeat the procedure.     

Comparison of Water Immersion Versus Air Insufflation Colonoscopy Under Various Bowel Preparation Conditions

Background: To investigate the differences between water immersion (WI) and air insufflation (AI) for colonoscopy under various bowel preparation conditions. Methods: In this study, 526 outpatients were randomly assigned to two groups, namely a WI group (n = 263) and an AI group (n = 263). During the procedure, the quality of bowel preparation, abdominal pain score, cecal intubation rate (CIR), adenoma detection rate (ADR), the intubation times, and other indicators were recorded. After reaching the cecum, each group of patients was subdivided into one of four grades (excellent, good, fair, and poor) according to the quality of bowel preparation.Results: Under various bowel preparation conditions, the pain scores of the AI group were higher than those of the WI group (P < .05), but there was no significant difference between the two groups in CIR (P > .05). For the WI group compared with the AI group, the cecal intubation time (CIT) was prolonged under good bowel preparation (P = .045) and fair bowel preparation (P < .001). No significant differences were observed between the two groups on ADR in all patients (P = .476).Conclusion: Compared with AI colonoscopy, WI colonoscopy can decrease colonoscopy-related pain in patients for unsedated colonoscopy under various bowel preparation conditions, but there is no significant difference in CIR. WI colonoscopy requires longer CIT in patients with good and fair bowel preparation conditions. WI colonoscopy does not significantly increase ADR.     

Pilot Feasibility Study of the Method of Water Infusion Without Air Insufflation in Sedated Colonoscopy

One study in sedated patients demonstrated a reduction in pain score but not midazolam dosage when warm water infusion was used to manage colonic spasm. We describe pilot data with a modified warm water infusion technique. We tested the hypothesis that patients receiving even only half of the usual dose of sedation medications would have acceptable cecal intubation and tolerate the procedure well, based on retrospective review of prospectively collected data from a single Veterans Affairs (VA) medical center. Group 1 included 32 consecutive patients who received full-dose and group 2 included 43 consecutive patients who received half-dose premedication. Insertion of colonoscope was aided by warm water infusion in lieu of air insufflation. Pain scores during insertion, cecal intubation rate, and total amount of medications were monitored. The novel technique permitted equal cecal intubation rate at reduced total dose of medications. Pain scores were not significantly different. The uncontrolled nonrandomized observational nature of the data is one limitation. The nonsignificant difference in pain scores may be affected by a type II error. These pilot data suggest that insertion is feasible without air when water infusion is used. The novel technique may be a useful adjunct for minimizing the dosage of sedation medications without adversely affecting cecal intubation. Further study is needed to compare air insufflation and water infusion with regard to patient tolerance and success, particularly in the presence of an on-demand sedation policy.     

Carbon dioxide insufflation during colonoscopy in deeply sedated patients

AIM: To compare the impact of carbon dioxide (CO₂) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS: Patients referred for colonoscopy were randomized to receive either CO₂ or air insufflation during the procedure. Both the colonoscopist and patient were blinded to the type of gas used. During the procedure, insertion and withdrawal times, caecal intubation rates, total sedation given and capnography readings were recorded. The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale (VAS) (0-3). Patients then graded their level of discomfort and abdominal bloating using a similar VAS. Complications during and after the procedure were recorded.RESULTS: A total of 142 patients were randomized with 72 in the air arm and 70 in the CO₂ arm. Mean age between the two study groups were similar. Insertion time to the caecum was quicker in the CO₂ group at 7.3 min vs 9.9 min with air (P = 0.0083). The average withdrawal times were not significantly different between the two groups. Caecal intubation rates were 94.4% and 100% in the air and CO₂ groups respectively (P = 0.012). The level of discomfort assessed by the nurse was 0.69 (air) and 0.39 (CO₂) (P = 0.0155) and by the patient 0.82 (air) and 0.46 (CO₂) (P = 0.0228). The level of abdominal bloating was 0.97 (air) and 0.36 (CO₂) (P = 0.001). Capnography readings trended to be higher in the CO₂ group at the commencement, caecal intubation, and conclusion of the procedure, even though this was not significantly different when compared to readings obtained during air insufflation. There were no complications in both arms.CONCLUSION: CO₂ insufflation during colonoscopy is more efficacious than air, allowing quicker and better cecal intubation rates. Abdominal discomfort and bloating were significantly less with CO₂ insufflation.     

Bristol大便性状分型量表对拟行肠镜检查老年人肠道准备的指导价值

目的 评价Bristol大便性状分型量表(BSFS)对老年人肠道准备质量的指导价值及强化肠道准备方案对Bristol大便性状1型及2型老年患者的效果及耐受性。方法 选取2019年3月至12月于北京老年医院内镜中心预约肠镜检查的患者240例,采用随机数表法将Bristol 大便性状1型及2型的患者分为A组、B组,其余3～7型患者为C组。A、C组应用聚乙二醇电解质散行标准肠道准备方案,B组应用聚乙二醇电解质散联合莫沙必利行强化肠道准备方案。采用肠道准备成功率、波士顿肠道准备评分(BBPS)、息肉检出率、进退镜时间及盲肠插管成功率评估患者肠道准备质量。记录患者不良反应发生情况、肠道准备满意度及重复肠道准备方案意愿。采用SPSS 19.0 统计软件进行数据分析,3组间比较采用单因素方差分析或 χ² 检验。结果 与A组相比,B、C组肠道准备成功率、BBPS、息肉检出率及盲肠插管成功率显著增高,进退镜时间显著降低,差异有统计学意义(均P<0.05)。与A组相比,C组肠道准备满意度、重复肠道准备方案意愿高(均P<0.05)。A、B组在恶心、腹胀发生率,肠道准备满意度及重复肠道准备方案意愿方面比较,差异有统计学意义(均P<0.05)。结论 BSFS量表对老年肠镜检查患者肠道准备质量有一定指导价值,Bristol 大便性状1型及2型的老年人行强化肠道准备方案有良好的效果及耐受性。     

Carbon Dioxide Insufflation or Warm-water Infusion for Unsedated Colonoscopy: A Randomized Controlled Trial in Patients with Chronic Constipation in China

Aims:

The effect of carbon dioxide (CO₂) insufflation and warm-water infusion during colonoscopy on patients with chronic constipation remains unknown. We evaluated CO₂ insufflation and warm-water irrigation versus air insufflation in unsedated patients with chronic constipation in China.

Patients and Methods:

This randomized, single–center, controlled trial enrolled 287 consecutive patients, from January 2014 to January 2015, who underwent colonoscopy for chronic constipation. Patients were randomized to CO₂ insufflation, warm-water irrigation and air insufflation colonoscopy insertion phase groups. Pain scores were assessed by the visual analog scale (VAS). The primary outcome was real-time maximum insertion pain, recorded by an unblinded nurse assistant. At discharge, the recalled maximum insertion pain was recorded. Meanwhile, patients were requested to select the VAS at 0, 10, 30, and 60 min after the procedure. In addition, cecal intubation and withdrawal time, total procedure time, and adjunct measures were recorded.

Results:

A total of 287 patients were randomized. The correlation between real-time and recalled maximum insertion pain ((Pearson coefficient r = 0.929; P < 0.0001) confirmed internal validation of the primary outcome. The mean real-time maximum pain scores during insertion 2.9 ± 2.1 for CO₂, 2.7 ± 1.9 for water achieved a significantly lower pain score compared with air (5.7 ± 2.5) group (air vs CO₂ P < 0.001; air vs water P < 0.001). However, no significant pain score differences were found between the patients in the CO₂ and water groups (CO₂ vs water, P = 0.0535). P values in painless colonoscopy and only discomfort colonoscopy (pain 1–2) were, respectively, 6 (6.4%) and 8 (8.5%) for air; 17 (17.7%) and 29 (30.2%) for CO₂; 16 (16.5%) and 31 (31.9%) for water. At 0, 10, 30, and 60 min postprocedure, pain scores showed in the CO₂ and water groups had significantly reduced than in air group. Insertion time was significantly different between air (10.6 ± 2.5) and CO₂ (7.2 ± 1.4) (air vs CO₂ P < 0.001), air and water (6.9 ± 1.3) (air vs water P < 0.001). However, CO₂ and was not significantly different in cecum-intubated time (CO₂ vs water, P = 0.404). CO₂ and water group in extubation time were significantly different, respectively, CO₂ (7.9 ± 1.1) and water (8.0 ± 1.1) (CO₂ vs water, P = 0.707). CO₂ or water group required less implementation of adjunct measures and more willingness to repeat the procedure.

Conclusions:

Compared with air, the CO₂ or water-aided method reduced real-time maximum pain and cecum-intubated time for chronic constipated patients in unsedated colonoscopy. The CO₂ insufflation or warm-water irrigation may be a simple and inexpensive way to reduce discomfort in unsedated patients with constipation. This study demonstrated an advantage of using CO₂ insufflation and warm-water irrigation during colonoscopy in unsedated constipated patients in China.Key Words: Air insufflation, carbon dioxide insufflation, constipation, unsedated colonoscopy, warm–water infusion