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CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(01): E67-E75
DOI: 10.1055/s-0042-118702
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Carbon dioxide versus room air insufflation during balloon-assisted enteroscopy: A systematic review with meta-analysis

Ashok Shiani
1   Department of Internal Medicine, University of South Florida, Tampa, Florida, United States
,
Seth Lipka
2   Department of Digestive Diseases and Nutrition, University of South Florida, Tampa, Florida, United States
,
Andrew Lai
4   Morsani College of Medicine Medical School, University of South Florida, Tampa, Florida, United States
,
Andrea C. Rodriguez
1   Department of Internal Medicine, University of South Florida, Tampa, Florida, United States
,
Christian M. Andrade
2   Department of Digestive Diseases and Nutrition, University of South Florida, Tampa, Florida, United States
,
Ambuj Kumar
3   Department of Evidence Based Medicine, University of South Florida, Tampa, Florida, United States
,
Patrick Brady
2   Department of Digestive Diseases and Nutrition, University of South Florida, Tampa, Florida, United States
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Publikationsverlauf

submitted 19. Mai 2016

accepted after revision 04. Oktober 2016

Publikationsdatum:
25. Januar 2017 (online)

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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.

 

  • References

  • 1 Domagk D, Mensink P, Aktas H. et al. Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial. Endoscopy 2011; 43: 472-476
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 2 Bretthauer M, Hoff GS, Thiis-Evensen E. et al. Air and carbon dioxide volumes insufflated during colonoscopy. Gastrointest Endosc 2003; 58: 203-206
    CrossrefPubMedGoogle Scholar
  • 3 Dellon ES, Velayudham A, Clarke BW. et al. A randomized, controlled, double-blind trial of air vs carbon dioxide insufflation during ERCP. Gastrointestinal endoscopy 2010; 72: 68-77
    CrossrefPubMedGoogle Scholar
  • 4 Church J, Delaney C. Randomized, controlled trial of carbon dioxide insufflation during colonoscopy. Dis Colon Rectum 2003; 46: 322-326
    CrossrefPubMedGoogle Scholar
  • 5 Wang WL, Wu ZH, Sun Q. et al. Meta-analysis: the use of carbon dioxide insufflation vs. room air insufflation for gastrointestinal endoscopy. Aliment Pharmacol Ther 2012; 35: 1145-1154
    CrossrefPubMedGoogle Scholar
  • 6 Domagk D, Bretthauer M, Lenz P. et al. Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled, double-blind trial. Endoscopy 2007; 39: 1064-1067
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 7 Hirai F, Beppu T, Nishimura T. et al. Carbon dioxide insufflation compared with air insufflation in double-balloon enteroscopy: a prospective, randomized, double-blind trial. Gastrointest Endosc 2011; 73: 743-749
    CrossrefPubMedGoogle Scholar
  • 8 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed) 1997; 315: 629-634
    CrossrefPubMedGoogle Scholar
  • 9 DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled clinical trials 1986; 7: 177-188
    CrossrefPubMedGoogle Scholar
  • 10 Balshem H, Helfand M, Schunemann HJ. et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of clinical epidemiology 2011; 64: 401-406
    CrossrefPubMedGoogle Scholar
  • 11 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines 6. Rating the quality of evidence--imprecision. Journal of clinical epidemiology 2011; 64: 1283-1293
    CrossrefPubMedGoogle Scholar
  • 12 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence--inconsistency. J Clin Epidemiol 2011; 64: 1294-1302
    CrossrefPubMedGoogle Scholar
  • 13 Guyatt GH, Oxman AD, Montori V. et al. GRADE guidelines: 5. Rating the quality of evidence--publication bias. J Clin Epidemiol 2011; 64: 1277-1282
    CrossrefPubMedGoogle Scholar
  • 14 Guyatt GH, Oxman AD, Vist G. et al. GRADE guidelines: 4. Rating the quality of evidence – study limitations (risk of bias). J Clin Epidemiol 2011; 64: 407-415
    CrossrefPubMedGoogle Scholar
  • 15 Moher D, Altman DG, Liberati A. et al. PRISMA statement. Epidemiology 2011; 22: 128 ; author reply 128
    CrossrefPubMedGoogle Scholar
  • 16 Li X, Zhao YJ, Dai J. et al. Carbon dioxide insufflation improves the intubation depth and total enteroscopy rate in single-balloon enteroscopy: a randomised, controlled, double-blind trial. Gut 2014; 63: 1560-1565
    CrossrefPubMedGoogle Scholar
  • 17 Lenz P, Meister T, Manno M. et al. CO2 insufflation during single-balloon enteroscopy: a multicenter randomized controlled trial. Endoscopy 2014; 46: 53-58
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 18 Ishizaki Y, Bandai Y, Shimomura K. et al. Safe intraabdominal pressure of carbon dioxide pneumoperitoneum during laparoscopic surgery. Surgery 1993; 114: 549-554
    PubMedGoogle Scholar
  • 19 Sanaka MR, Navaneethan U, Kosuru B. et al. Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small-bowel disease. Clin Gastroenterol Hepatol 2012; 10: 910-916
    CrossrefPubMedGoogle Scholar