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Insufflation of the colon is necessary to distend the lumen for exploration. Carbon dioxide (CO2) insufflation instead of air insufflation (AI) has shown conflicting results about decreasing pain or discomfort during the procedure, even when coupled with water immersion or water exchange method of insertion. CO2 insufflation is associated with a reasonably consistent decrease in bloating and pain scores in the post-procedure period. Other advantages are a decrease in toilet use, less incontinence and less flatulence after colonoscopy. No definitive results are available about the effect of CO2 on the need and dosage of sedation medication(s). Association with water-aided methods appears to show promise in decreasing pain during and after the procedure, achieve higher rates of minimally sedated or unsedated colonoscopy, with less postprocedure bloating and flatulence. Further studies are needed to investigate the impact of combining water-aided methods with CO2 on clinically relevant parameters.

1Digestive Endoscopy Unit, S. Barbara Hospital, Iglesias (CI), Italy; 2Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale (VS), Italy; 3Department of Surgical Sciences, University of Cagliari (CA), Italy; 4Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA; 5David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA

1Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System and 2David Geffen School of Medicine at University of California at Los Angeles, North Hills, CA, United States; 3Digestive Endoscopy Unit, S. Barbara Hospital, Iglesias, Italy; 4Digestive Diseases Center, Vi tkovice Hospital, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 5Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan; 6Buddhist Tzu Chi University, School of Medicine, Hualien, Taiwan; 7Gastroenterology, Sacramento Veterans Affairs Medical Center, Veterans Affairs Northern California Health Care System, Mather, CA, and 8Gastroenterology, University of California at Davis Medical Center, Sacramento, CA, United States; 9Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; 10Division of Gastroenterology, Valduce Hospital, Como, Italy