As mentioned above, many practitioners promulgate carbon dioxide as superior to air, largely based on barium enema and colonoscopy literature, which suggests it causes less discomfort because of its rapid mucosal absorption (Grant et al. 1986; Church and Delaney 2003). A recent study (Iafrate et al. 2004) also showed improved patient tolerance using automated carbon dioxide administration vs manually administered room air, although it is not clear whether the benefit was derived from using the automated device or carbon dioxide gas. Using a validated patient satisfaction questionnaire, the authors recently compared automated vs manual carbon dioxide insufflation and found virtually no difference between the two methods (Burling et al. 2005), suggesting that in the study by Iafrate et al. (2004), the use of carbon dioxide gas was the most important factor. An additional advantage of rapid mucosal absorption is that it significantly reduces the technical difficulties associated with a distended colon when performing colonoscopy immediately after CT colonography.
The choice of insufflated gas is ultimately dependent on the preference of the individual practitioner. Patients probably prefer carbon dioxide but the administration is relatively complicated and more expensive than bulb insufflation of room air. In a recent survey of international experts asked which gas they would advocate, 50% expressed no preference at all (Barish et al. 2005). Of the remainder, two-thirds preferred carbon dioxide over air.
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