Effects of carbon dioxide insufflation in balloon‐assisted enteroscopy: A systematic review and meta‐analysis

Nishizawa, Toshihiro; Suzuki, Hidekazu; Fujimoto, Ai; Ochiai, Yasutoshi; Kanai, Takanori; Yahagi, Naohisa

doi:10.1177/2050640615588024

Cited by 18 publications

(21 citation statements)

References 21 publications

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“…its impact on patient comfort and insertion depth [239 -242]. A systematic review with meta-analysis by Nishizawa et al [243] has recently analyzed 4 RCTs (2 on DBE and 2 on SBE; 461 patients overall, 235 randomized to undergo enteroscopy with air and 226 with CO 2 insufflation) that aimed to evaluate the impact of CO 2 in DAE procedures. When compared with air, use of CO 2 insufflation significantly increased the insertion depth for antegrade enteroscopy, but not for the retrograde approach.…”

Section: Recommendationmentioning

confidence: 99%

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

et al. 2018

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1: ESGE recommends performing diagnostic DAE as a day-case procedure in patients without significant underlying co-morbidities; in patients with co-morbidities and/or those undergoing a therapeutic procedure, an inpatient stay is recommended.Strong recommendation, low quality evidenceThe choice between different settings also depends on sedation protocols.Strong recommendation, low quality evidence. 2: ESGE suggests that conscious sedation, deep sedation, and general anesthesia are all acceptable alternatives: the choice between them should be governed by procedure complexity, clinical factors, and local organizational protocols.Weak recommendation, low quality evidence. 3: ESGE recommends that the findings of previous diagnostic investigations should guide the choice of insertion route.Strong recommendation, moderate quality evidence.If the location of the small-bowel lesion is unknown or uncertain, ESGE recommends that the antegrade route should be generally preferred.Strong recommendation, low quality evidence.In the setting of massive overt bleeding, ESGE recommends an initial antegrade approach.Strong recommendation, low quality evidence. 4: ESGE recommends that, for balloon-assisted enteroscopy (i. e., single-balloon enteroscopy [SBE] and double-balloon enteroscopy [DBE]), small-bowel insertion depth should be estimated by counting net advancement of the enteroscope during the insertion phase, with confirmation of this estimate during withdrawal.Strong recommendation, low quality evidence.ESGE recommends that, for spiral enteroscopy, insertion depth should be estimated during withdrawal.Strong recommendation, moderate quality evidence. Since the calculated insertion depth is only a rough estimate, ESGE recommends placing a tattoo to mark the identified lesion and/or the deepest point of insertion.Strong recommendation, low quality evidence. 5: ESGE recommends that all endoscopic therapeutic procedures can be undertaken at the time of DAE.Strong recommendation, moderate quality evidence.Moreover, when therapeutic interventions are performed, additional specific safety measures are needed to prevent complications.Strong recommendation, high quality evidence.

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Section: Recommendationmentioning

confidence: 99%

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

et al. 2018

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“…Statistical analysis was conducted using the Review Manager (RevMan; The Cochrane Collaboration, 2008; The Nordic Cochrane Centre, Copenhagen, Denmark). We used a random-effects model and Mantel-Haenszel method to calculate the odds ratio (OR), and we used inverse variance for the continuous data to estimate the weighted mean difference (WMD) with 95% confidence intervals (CI) [12]. Heterogeneity in the results of the studies was assessed by Cochran's Q and I 2 tests.…”

Section: Discussionmentioning

confidence: 99%

Effects of Encircled Abdominal Compression Device in Colonoscopy: A Meta-Analysis

Nishizawa

Suzuki

Higuchi

et al. 2019

JCM

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Background and Aim: The efficacy of encircling abdominal compression devices in colonoscopies is inconsistent. We performed a meta-analysis of randomized controlled trials (RCTs) in which encircling abdominal compression devices were compared with control in colonoscopies. Methods: We systematically searched RCTs published in the Cochrane Library, PubMed, and the Igaku-Chuo-Zasshi database. The data from the eligible RCTs were combined using the random-effects model. The weighted mean differences (WMDs), pooled odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Results: Five RCTs were included in this meta-analysis. Compared to the control group, encircling abdominal compression devices significantly reduced the caecal intubation time (WMD: −1.31, 95% CI: −2.40 to −0.23, p = 0.02). Compared to the control group, encircling abdominal compression devices significantly decreased the frequency of postural change (OR 0.30, 95% CI: 0.22 to 0.41, p < 0.00001). Compared to the control group, the use of encircling abdominal compression devices significantly reduced the need for abdominal compression (OR: 0.35, 95% CI: 0.17 to 0.70, p = 0.003). Conclusions: Encircling abdominal compression devices in colonoscopies was found to reduce the caecal intubation time and the frequency of abdominal compression.

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“…It is noteworthy that a systematic review with meta-analysis was performed in 2016 5 , where the depth of intubation, abdominal pain, and CO 2 retention were analyzed, not all other outcomes or subgroups that the present review was able to list and analyze.…”

Section: Discussionmentioning

confidence: 99%

“…It is worth mentioning that many studies have already compared the use of ambient air and CO 2 in the various endoscopic procedures, and recently 2 systematic reviews with meta-analysis 5 6 have shown outcomes that have been analyzed in subgroups and that were not previously analyzed. On this premise, this systematic revision is conducted to substantiate the comparison of the use of CO 2 in relation to conventional air using the information available in the literature from randomized clinical trials (RCTs) already performed.…”

Section: Introductionmentioning

confidence: 99%

Carbon dioxide versus air insufflation enteroscopy: a systematic review and meta-analysis based on randomized controlled trials

et al. 2018

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Objectives To compare the insufflation of CO 2 and ambient air in enteroscopy. Search sources The investigators researched the electronic databases MedLine, Cochrane Library, Central, LILACS, BVS, Scopus and Cinahl. The grey search was conducted in the base of theses of the University of São Paulo, books of digestive endoscopy and references of selected articles and in previous systematic revisions. Study eligibility criteria The evaluation of eligibility was performed independently, in a non-blind manner, by two reviewers, firstly by title and abstract, followed by complete text. Disagreements between the reviewers were resolved by consensus. Data collection and analysis method Through the spreadsheet of data extraction, where one author extracted the data and a second author checked the extraction. Disagreements were resolved by debate between the two reviewers. The quality analysis of the studies was performed using the Jadad score. The software RevMan 5 version 5.3 was used for the meta-analysis. Results Four randomized clinical trials were identified, totaling 473 patients submitted to enteroscopy and comparing insufflation of CO 2 and ambient air. There was no statistical difference in the intubation depth between the two groups. When CO 2 insufflation was reduced, there was a significant difference in pain levels 1 hour after the procedure (95 % IC, –2.49 [–4.72, –0.26], P : 0.03, I 2 : 20%) and 3 hours after the procedure (95% IC, –3.05 [–5.92, –0.18], P : 0.04, I 2 : 0 %). There was a usage of lower propofol dosage in the CO 2 insufflation group, with significant difference (95 % IC, –67.68 [–115.53, –19.84], P : 0.006, I 2 : 0 %). There was no significant difference between the groups in relation to the use of pethidine and to the oxygen saturation. Limitations Restricted number of randomized clinical trials and nonuniformity of data were limitations to the analysis of the outcomes. Conclusion The use of CO 2 as insufflation gas in enteroscopy reduces the pain levels 1 hour and 3 hours after the procedure, in addition to the reduction of the sedation (propofol) dosage used.

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Effects of carbon dioxide insufflation in balloon‐assisted enteroscopy: A systematic review and meta‐analysis

Cited by 18 publications

References 21 publications

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Effects of Encircled Abdominal Compression Device in Colonoscopy: A Meta-Analysis

Carbon dioxide versus air insufflation enteroscopy: a systematic review and meta-analysis based on randomized controlled trials

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