META-ANALYSES

Meta-analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy

  1. W. L. Wang1,2,
  2. Z. H. Wu1,2,
  3. Q. Sun1,2,
  4. J. F. Wei1,2,
  5. X. F. Chen1,2,
  6. D. K. Zhou1,2,
  7. L. Zhou1,2,
  8. H. Y. Xie1,2,
  9. S. S. Zheng1,2,*

Article first published online: 27 MAR 2012

DOI: 10.1111/j.1365-2036.2012.05078.x

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 35, Issue 10, pages 1145–1154, May 2012

Additional Information

How to Cite

Wang, W. L., Wu, Z. H., Sun, Q., Wei, J. F., Chen, X. F., Zhou, D. K., Zhou, L., Xie, H. Y. and Zheng, S. S. (2012), Meta-analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy. Alimentary Pharmacology & Therapeutics, 35: 1145–1154. doi: 10.1111/j.1365-2036.2012.05078.x

Author Information

  1. 1

    Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China

  2. 2

    Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang province, China

*Correspondence to:
Dr S. S. Zheng, First Affiliated Hospital, Medical College, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China.
E-mails: shusenzheng@zju.edu.cn; wam@zju.edu.cn

  1. As part of AP&T's peer-review process, a technical check of this meta-analysis was performed by Dr. P. Collins.

Publication History

  1. Issue published online: 15 APR 2012
  2. Article first published online: 27 MAR 2012
  3. Manuscript Accepted: 7 MAR 2012
  4. Manuscript Revised: 6 MAR 2012
  5. Manuscript Revised: 13 SEP 2011
  6. Manuscript Received: 15 AUG 2011

Funded by

  • National Natural Science foundation of China. Grant Number: 30901787
  • Major Program of the Science and Technology Bureau of Zhejiang Province. Grant Number: 2009C03012-1
  • National S&T Major Project. Grant Number: 2008ZX10002-026
  • Projects of International Cooperation and Exchanges NSFC. Grant Number: 30731160620

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Summary

Background

Carbon dioxide (CO2) insufflation has been proposed as an alternative to air insufflation to distend the lumen in gastrointestinal (GI) endoscopy.

Aim

To perform a systematic review with meta-analysis of randomised controlled trials (RCTs) in which CO2 insufflation was compared with room air insufflation in GI endoscopy.

Methods

Electronic and manual searches were combined to search RCTs. After methodological quality assessment and data extraction, the efficacy and safety of CO2 insufflation were systematically assessed.

Results

Twenty-one RCTs [13 on colonoscopy, four on endoscopic retrograde cholangiopancreatography (ERCP), two on double-balloon enteroscopy (DBE), one on oesophagogastroduodenoscopy, and one on flexible sigmoidoscopy] were identified. For colonoscopy, CO2 insufflation resulted lower postprocedural pain intensity, and increased the proportion of patient without pain at 1 h (RR: 1.84, 95% CI: 1.37–2.47) and 6 h (RR: 1.28; 95% CI: 1.14–1.44) postprocedure. For ERCP, the pain-releasing effect of CO2 insufflation was not obvious (SMD: −1.48, 95% CI: −3.56, 0.59). CO2 insufflation revealed no consistent advantages in the RCTs of DBE, but was shown as safe as air insufflation in oesophagus/stomach endoscopic submucosal dissection in one study. pCO2 level showed no significant variation during these procedures.

Conclusions

Compared with air insufflation, CO2 insufflation during colonoscopy causes lower postprocedural pain and bowel distension without significant pCO2 variation. More RCTs are needed to assess its advantages in other GI endoscopic procedures.

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