938 COMPARISON BETWEEN AIR VS CARBON DIOXIDE INSUFFLATION IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A META-ANALYSIS

Abstract

Abdominal distention is used to increase the ability of visualization during ERCP. Air and carbon dioxide are the most commonly used substances for insufflation. Each method has its own merits and setbacks with regards to adverse events like procedure time, post-operative pain, and abdominal distension. This meta-analysis is intended address these aspects of these two different approaches. PubMed database was searched through December 2017. Eight studies comparing ERCP with air vs carbon dioxide. End points were post-operative incidence of pancreatitis, pain at subsequent time intervals, abdominal girth and time for the whole procedure. The odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) was computed and p<0.05 was considered as a level of significance. Using Carbon dioxide during ERCP was associated with lower rate of pain at 1, 3 and 24 hours post ERCP (5.59 CI 4.92-6.26, 14.10 CI 12.91-15.29, 3.00 CI 2.44-3.57 respectively). Pain at 1 Hour Post ERCP. Pain at 3 hours Post ERCP Pain at 24 hours Post ERCP. However there was no significant difference in the duration of procedure when Carbon dioxide was used in comparison to air (0.78 CI -1.95-3.50). ERCP Procedure Time. Three of the eight studies looked at the difference in abdominal distension post ERCP at 3 hours and 24 hours when carbon dioxide was compared to when air was used respectively (4.31 CI 2.06-6.57, -0.70 CI -1.81-0.42) and there was significant difference at 3 hours post ERCP and there was no significant difference at 24 hours. when carbon dioxide was compared to when air was used. Abdominal distension 3 hours after ERCP. Abdominal distension 24 hours after ERCP. The use of carbon dioxide during ERCP was associated with less post procedural pain when compared to air insufflation. On the hand, there was no statistically significant difference in procedural time as well as abdominal distension at 24 hours between carbon dioxide and air insufflation. Therefore, this meta-analysis supports the use of carbon dioxide over air for ERCP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)