Carbon dioxide insufflation versus air insufflation during endoscopic retrograde cholangiopancreatography: a meta-analysis

Abstract

Background and aims: Adequate visualization during endoscopic retrograde cholangiopancreatography (ERCP) procedure requires distention of the bowel lumen, usually insufflated with room air. Patients often complain of abdominal pain post-procedure. The use of carbon dioxide insufflation in colonoscopy has been shownto result in less post-procedure abdominal pain and distension. Recently, it has been reported the use of carbon dioxide (CO2) insufflation during ERCP procedure is similarly helpful. The purpose of this study was to evaluate the efficiency, safety and comfort of ERCP involving carbon dioxide insufflation through a meta-analysis of published randomized control trials. Methods: Databases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index and momentous meeting abstracts were searched and evaluated by two reviewers independently. Results: Five randomized control trials involving 446 patients were analyzed. Meta-analysis showed that patientsin the CO2 insufflation group had lower pain score (VAS) at 1-hour [MD -12.37, 95%CI(-20.96,-3.78)], 3-hours [MD -9.81, 95%CI (-17.05, -2.57)) and 6-hours [MD -8.78, 95%CI (-13.71, -3.85)] compared with air insufflation group after procedure. However, there were no significant differences between the two groups regardingtotal procedure time and procedure complication. Conclusions: Insufflation with carbon dioxide during ERCP may decrease post-procedure abdominal discomfort without any additional adverse reactions. Thus, CO2 insufflation seems appropriate to use during ERCP procedure. Large trials are required to prove any additional advantages to carbon dioxide insufflation during ERCP.