Abstract
Background and study aims Carbon dioxide (CO2) insufflation has
been suggested to be an ideal alternative to room air insufflation to reduce
trapped air within the bowel lumen after balloon assisted enteroscopy (BAE). We
performed a systematic review and meta-analysis to assess the safety and
efficacy of utilizing CO2 insufflation as compared to room air during
BAE.
Patients and methods The primary outcome is mean change in visual analog
scale (VAS; 10 cm) at 1, 3, and 6 hours to assess pain. Secondary outcomes
include insertion depth (anterograde or retrograde), adverse events, total
enteroscopy rate, diagnostic yield, mean anesthetic dosage, and PaCO2
at procedure completion. We searched MEDLINE and the Cochrane Central Register
of Controlled Trials (CENTRAL) from inception until May 2015. Multiple
independent extractions were performed, the process was executed as per the
standards of the Cochrane collaboration.
Results Four randomized controlled trials (RCTs) were included in the
meta-analysis. VAS at 6 hours favored CO2 over room air (MD 0.13;
95 % CI 0.01, 0.25; p = 0.03). Anterograde insertion depth (cm) was improved in
the CO2 group (MD, 58.2; 95 % CI 17.17, 99.23; p = 0.005), with an
improvement in total enteroscopy rate in the CO2 group (RR 1.91; 95 %
CI 1.20, 3.06; p = 0.007). Mean dose of propofol (mg) favored CO2
compared to air (MD, – 70.53; 95 % CI – 115.07, – 25.98; P = 0.002).
There were no differences in adverse events in either group.
Conclusions Despite the ability of CO2 to improve insertion
depth and decrease amount of anesthesia required, further randomized control
trials are needed to determine the agent of choice for insufflation in balloon
assisted enteroscopy.
Carbon
dioxide versus room air insufflation during balloon-assisted enteroscopy: A
systematic review with meta-analysis
