Carbon Dioxide Versus Room Air Insufflation During Balloon Assisted Enteroscopy: A Systematic Review and Meta-analysis

Abstract

Introduction: Carbon dioxide (CO2) insufflation has been suggested to be an ideal alternative to room air insufflation in order 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. Methods: We searched MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception until May 10, 2015, as well as other databases. For quality assurance purposes throughout the systematic review, multiple independent extractions were performed and the process was executed as per the standards of the Cochrane collaboration. The primary outcome is the mean change in visual analog scale (VAS; 10 cm) at 1, 3, and 6 hours. Secondary outcomes include insertion depth (anterograde or retrograde) (cm), adverse events, total enteroscopy rate, diagnostic yield, mean difference in anesthetic dosage (mg), and PaCO2 at procedure completion. Results: Four randomized control 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 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 favored CO 2 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. Conclusion: The results of this meta-analysis show a favorable effect of CO2 insufflation over air in BAE. CO2 insufflation improved insertion depths, total enteroscopy rate, and 6 hour VAS pain scores. CO2 should be the agent of choice in balloon assissted enteroscopy.Figure 1Figure 2