CO(2) insufflation versus air insufflation for endoscopic submucosal dissection: A meta-analysis of randomized controlled trials

BACKGROUND: Carbon dioxide (CO(2)) insufflation is increasingly used for endoscopic submucosal dissection (ESD) owing to the faster absorption of CO(2) as compared to that of air. Studies comparing CO(2) insufflation and air insufflation have reported conflicting results. OBJECTIVES: This meta-analysis is aimed to assess the efficacy and safety of use of CO(2) insufflation for ESD. METHODS: Clinical trials of CO(2) insufflation versus air insufflation for ESD were searched in PubMed, Embase, the Cochrane Library and Chinese Biomedical Literature Database. We performed a meta-analysis of all randomized controlled trials (RCTs). RESULTS: Eleven studies which compared the use of CO(2) insufflation and air insufflation, with a combined study population of 1026 patients, were included in the meta-analysis (n = 506 for CO(2) insufflation; n = 522 for air insufflation). Abdominal pain and VAS scores at 6h and 24h post-procedure in the CO(2) insufflation group were significantly lower than those in the air insufflation group, but not at 1h and 3h after ESD. The percentage of patients who experienced pain 1h and 24h post-procedure was obviously decreased. Use of CO(2) insufflation was associated with lower VAS scores for abdominal distention at 1h after ESD, but not at 24h after ESD. However, no significant differences were observed with respect to postoperative transcutaneous partial pressure carbon dioxide (PtcCO(2)), arterial blood carbon dioxide partial pressure (PaCO(2)), oxygen saturation (SpO(2)%), abdominal circumference, hospital stay, white blood cell (WBC) counts, C-Reactive protein (CRP) level, dosage of sedatives used, incidence of dysphagia and other complications. CONCLUSION: Use of CO(2) insufflation for ESD was safe and effective with regard to abdominal discomfort, procedure time, and the residual gas volume. However, there appeared no significant differences with respect to other parameters namely, PtcCO(2), PaCO(2), SpO(2)%, abdominal circumference, hospital stay, sedation dosage, complications, WBC, CRP, and dysphagia.