As part of AP&T's peer-review process, a technical check of this meta-analysis was performed by Dr. P. Collins.
Meta-analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy
Version of Record online: 27 MAR 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 10, pages 1145–1154, May 2012
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
- Issue online: 15 APR 2012
- Version of Record online: 27 MAR 2012
- Manuscript Accepted: 7 MAR 2012
- Manuscript Revised: 6 MAR 2012
- Manuscript Revised: 13 SEP 2011
- Manuscript Received: 15 AUG 2011
- 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
Carbon dioxide (CO2) insufflation has been proposed as an alternative to air insufflation to distend the lumen in gastrointestinal (GI) endoscopy.
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.
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.
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.
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.