Liverpool Day Surgery Leading the Way with CO2

Tuesday, September 16th, 2014

Colonoscopy is being increasingly performed in Australia and around the world. It is the gold standard test for the early detection of bowel cancer and increasingly being used for the prevention of bowel cancer by removal of pre-cancerous colonic polyps. The National Bowel Cancer Screening program is now in full swing, providing protection from bowel cancer for the Australian public, but also resulting in many more colonoscopies being performed.

The quality of colonoscopy has improved dramatically over the years, with high definition cameras now giving doctors the sharpest view they have ever had of the inside of the colon. In order to achieve such excellent views, the colon has to be distended to aid in the visualisation of its interior.

Previously this had been achieved by pumping room air into the colon. While this did the job, many patients were left with quite significant abdominal pain and cramping following the procedure, sometimes lasting for several hours and often delaying discharge from day surgery after the procedure. Occasionally pain was severe enough to warrant overnight admission.

Carbon dioxide (CO2) is a gas that is rapidly absorbed into the blood stream and does not last long within body tissues. It ‘dissolves’ into the blood stream and is then exhaled in the breath. This quality has made it ideal for use in laparoscopic surgery, where it is used to inflate the inside of the abdomen, but then quickly diffuses into the blood stream and is exhaled in the breath. Similar to laparoscopy, colonoscopy involves the insufflation of gas into the colon.

Switching from room air to CO2 to insufflate the colon has resulted in dramatic improvements to patient comfort following the procedure. It is now extremely rare to have patients with significant pain following colonoscopy where CO2 has been used instead of room air.

Liverpool Day Surgery (LDS) switched from air to CO2 insufflation some time ago. The doctors noted a dramatic and immediate reduction in post colonoscopy patient discomfort. So much so, that the switch to CO2, long discussed at Liverpool Hospital by the same doctors, was expedited due to their experience at LDS. It is now rare for a patient to have their discharge delayed following colonoscopy and many patients who have had colonoscopy previously with air insufflation have commented on how much better it is now.

Dr David Abi-Hanna

Gastroenterologist, MBBS, FRACP, BSc(MED), PhD