Total Colonic Decompression Fails to Decrease Post- Colonoscopy Abdominal Pain: A Double-Blind Randomized Controlled Trial

Abstract

Background/Aims: Post-colonoscopy pain is among the most common minor side effects of colonoscopy. Total colonic decompression, involving the decompression of intraluminal air from the colon through reinsertion of the colonoscope to the cecum post-colonoscopy, is proposed to reduce this pain. This study aims to evaluate the effect of total colonic decompression on post-colonoscopy abdominal pain.

Materials and Methods: A total of 240 eligible colonoscopy participants were randomized (1 : 1) into the decompression and control groups. In the decompression group, the cecum was reintubated, and the colonoscope was withdrawn with air aspiration post colonoscopy. However, this maneuver was omitted in the control group. Demographics, vital signs, anesthetic doses, procedure duration, and interventions were recorded. Abdominal pain was assessed using a 10-point Visual Analog Scale within 30 minutes and again at 24 hours post-procedure.

Results: The final analysis included 114 participants in the decompression group and 104 in the control group. Clinical and demographic characteristics were comparable between groups. Post-colonoscopy pain occurred in 17 patients (14.9%) in the decompression group and 20 patients (19.2%) in the control group (P = .396) within 30 minutes post procedure. At 24 hours post-procedure, the rates were 2.6% and 3.8%, respectively (P = .712). The administered propofol dose (196.5 ± 60.5 vs. 177.3 ± 39.0 mg, P = .005) and hypoxia (SpO2: 94.9 ± 5.2% vs. 96.4 ± 2.8%, P = .006) were significantly higher in the decompression group.

Conclusion: Total colonic decompression does not alleviate post-colonoscopy abdominal pain and is associated with a higher propofol dose, leading to hypoxia.

Cite this article as: Aslan E, Teker MG, Bas S, Pinarbasi Simsek B. Total colonic decompression fails to decrease post-colonoscopy abdominal pain: A double-blind randomized controlled trial. Turk J Gastroenterol. Published online January 15, 2026. doi: 10.5152/tjg.2026.25559.