Efficacy and safety of carbon dioxide insufflation versus air insufflation during endoscopic retrograde cholangiopancreatography in randomized controlled trials: a systematic review and meta-analysis

Abstract

Background and study aims Ambient air is the most commonly used gas for insufflation in endoscopic procedures worldwide. However, prolonged absorption of air during endoscopic examinations may cause pain and abdominal distension. Carbon dioxide insufflation (CO2i) has been increasingly used as an alternative to ambient air insufflation (AAi) in many endoscopic procedures due to its fast diffusion properties and less abdominal distention and pain. For endoscopic retrograde cholangiopancreatography (ERCP), use of CO2 for insufflation is adequate because this procedure is complex and prolonged. Some randomized controlled trials (RCTs) have evaluated the efficacy and safety of CO2 as an insufflation method during ERCP but presented conflicting results. This systematic review and meta-analysis with only RCTs evaluated the efficacy and safety of CO2i versus AAi during ERCP. Methods A literature search was performed using online databases with no restriction regarding idiom or year of publication. Data were extracted by two authors according to a predefined data extraction form. Outcomes evaluated were abdominal pain and distension, complications, procedure duration, and CO2 levels. Results Eight studies (919 patients) were included. Significant results favoring CO2i were less abdominal distension after 1 h (MD: −1.41 [−1.81; −1.0], 95 % CI, I² = 15 %, P < 0.00001) and less abdominal pain after 1 h (MD: −23.80 [−27.50; −20.10], 95 %CI, I² = 9 %, P < 0.00001) and after 6 h (MD: −7.00 [−8.66; −5.33]; 95 % CI, I² = 0 %, P < 0.00001). Conclusion Use of CO2i instead of AAi during ERCP is safe and associated with less abdominal distension and pain after the procedure.

Pancreatitis after endoscopic retrograde cholangiopancreatography: A narrative review

“…Not all patients with pain after ERCP have pancreatitis. Other causes of abdominal pain after ERCP include discomfort due to air insufflation[ 42 - 44 ] and perforation.…”

Insufflation of Carbon Dioxide versus Air During Colonoscopy Among Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…15,16 Rogers 17 conducted a small study that first reported on the benefit of using CO 2 insufflation during colonoscopy, owing to the properties of fast absorption and improvement of adverse events caused by abdominal distention; since then CO 2 has been used for a wide variety of endoscopic procedures. 14,[18][19][20] However, evidence for the use of CO 2 insufflation during colonoscopies among pediatric population remains scarce, with data largely extrapolated from adults. The main objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effectiveness of CO 2 versus air insufflation in pediatric patients undergoing colonoscopy.…”

Carbon Dioxide vs. Air Insufflation for Pediatric Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…On the other hand, with increased accuracy of serological tests, endoscopic investigations can be avoided for patients with celiac disease ( 16 ). Despite numerous clinical trials and reviews on the use of CO 2 insufflation for endoscopy in adults ( 7 , 9 , 17 , 18 ), data concerning pediatric patients is scarce. Over the past few years, studies have evaluated the benefits of CO 2 insufflation during GI endoscopy in pediatric patients.…”