Intest Res  
Difficult colonoscopy: air, carbon dioxide, or water insufflation?
Alisha Chaubal, Vikas Pandey, Ruchir Patel, Prateik Poddar, Aniruddha Phadke, Meghraj Ingle, Prabha Sawant
Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
Correspondence to: Alisha Chaubal, Department of Gastroenterology, Lokmanya Tilak Medical General Hospital, Lokmanya Tilak Medical College, Mumbai 400022 , India. Tel: +91-22-2406-3077, E-mail:
Received: April 25, 2017; Revised: May 26, 2017; Accepted: June 26, 2017; Published online: November 10, 2017.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background/Aims: This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation). Methods: Patients with body mass index (BMI) less than 18 kg/m2 or more than 30 kg/m2, or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation. Results: The primary end point was achieved in 31.8%, 45.0%, and 84.1% of cases with air, carbon dioxide and water insufflation (p〈 0.001). The mean pain scores were 5.17, 4.72, and 3.93 on the VAS for air, carbon dioxide, and water insufflation (p〈 0.001). The cecal intubation rate or procedure time did not differ significantly between the 3 groups. Conclusions: Water insufflation was superior to air or carbon dioxide for pain tolerance. This was seen in the subgroups with BMI 〈18 kg/m2 and the postsurgical group, but not in the group with BMI >30 kg/m2.
Keywords: Colonoscopy; Insufflation; Carbon dioxide insufflation; Water immersion

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