Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 21, 2012; 18(39): 5622-5631
Published online Oct 21, 2012. doi: 10.3748/wjg.v18.i39.5622
Carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography: A meta-analysis and systematic review
Yao Cheng, Xian-Ze Xiong, Si-Jia Wu, Jiong Lu, Yi-Xin Lin, Nan-Sheng Cheng, Tai-Xiang Wu
Yao Cheng, Xian-Ze Xiong, Si-Jia Wu, Jiong Lu, Yi-Xin Lin, Nan-Sheng Cheng, Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Tai-Xiang Wu, Chinese Cochrane Centre, Chinese Clinical Trial Registry, Chinese Evidence-Based Medicine Centre, INCLEN Resource and Training Centre, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Cheng Y and Cheng NS designed the study; Wu SJ and Lu J performed the literature search and collected the data; Lin YX and Wu TX analyzed the data; Cheng Y and Xiong XZ wrote the paper.
Correspondence to: Nan-Sheng Cheng, MD, Professor, Department of Bile Duct Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. nanshengcheng@gmail.com
Telephone: +86-28-85422465 Fax: +86-28-85422465
Received: March 1, 2012
Revised: April 28, 2012
Accepted: May 5, 2012
Published online: October 21, 2012
Abstract

AIM: To assess the safety and efficacy of carbon dioxide (CO2) insufflation during endoscopic retrograde cholangiopancreatography (ERCP).

METHODS: The Cochrane Library, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Science Citation Index Expanded, Chinese Biomedical Literature Database, and references in relevant publications were searched up to December 2011 to identify randomized controlled trials (RCTs) comparing CO2 insufflation with air insufflation during ERCP. The trials were included in the review irrespective of sample size, publication status, or language. Study selection and data extraction were performed by two independent authors. The meta-analysis was performed using Review Manager 5.1.6. A random-effects model was used to analyze various outcomes. Sensitivity and subgroup analyses were performed if necessary.

RESULTS: Seven double-blind RCTs involving a total of 818 patients were identified that compared CO2 insufflation (n = 404) with air insufflation (n = 401) during ERCP. There were a total of 13 post-randomization dropouts in four RCTs. Six RCTs had a high risk of bias and one had a low risk of bias. None of the RCTs reported any severe gas-related adverse events in either group. A meta-analysis of 5 RCTs (n = 459) indicated that patients in the CO2 insufflation group had less post-ERCP abdominal pain and distension for at least 1 h compared with patients in the air insufflation group. There were no significant differences in mild cardiopulmonary complications [risk ratio (RR) = 0.43, 95% CI: 0.07-2.66, P = 0.36], cardiopulmonary (e.g., blood CO2 level) changes [standardized mean difference (SMD) = -0.97, 95% CI: -2.58-0.63, P = 0.23], cost analysis (mean difference = 3.14, 95% CI: -14.57-20.85, P = 0.73), and total procedure time (SMD = -0.05, 95% CI: -0.26-0.17, P = 0.67) between the two groups.

CONCLUSION: CO2 insufflation during ERCP appears to be safe and reduces post-ERCP abdominal pain and discomfort.

Keywords: Systematic review, Meta-analysis, Carbon dioxide insufflation, Endoscopic retrograde cholangiopancreatography, Abdominal pain