The usefulness of nasal high flow in endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis

Abstract

Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a critical procedure in gastroenterology, typically performed under sedation with the administration of supplemental oxygen. Nasal High Flow (NHF) is a newer method of oxygen administration combined with sedation for oxygen delivery. This meta-analysis was designed to identify the effects of NHF during ERCP. Method: Three major online databases (PubMed, Web of Science, and Cochrane) were searched on July 30, 2024. The search was not limited by publication language and focused on randomized controlled trials that compared the use of NHF with usual care in patients undergoing ERCP. Results: A total of 198 studies were identified after searching the three databases. Finally, five studies, encompassing a total of 581 patients, were included in the meta-analysis. The pooled analysis showed that using NHF was associated with a significantly lower incidence of hypoxemia than usual care. The odds ratio was 0.29 (95% Confidence Interval [CI]: 0.14–0.60, p < 0.001, I² = 21%). The NHF group showed a higher minimum SpO2 value during the procedure, with a 2.55% increase in the mean difference (95% CI: 0.96, 4.13, p = 0.002; I² = 57%). Compared to the usual care group, the NHF group demonstrated a reduction in CO2 partial pressure level at the end of the procedure, with a mean difference of 1.83 mmHg (95% CI: -3.25, -0.42, p = 0.01; I² = 0%). The duration of ERCP showed no statistically significant difference between the usual care group and the NHF group, with a mean difference of 0.7 minutes (95% CI: -0.14, 1.53, p = 0.1; I² = 0%). Conclusion: NHF effectively reduces the incidence of hypoxemia, supporting its consideration as the preferred method of oxygen delivery during ERCP, particularly for patients at higher risk of respiratory complications.