title: Carbon dioxide versus room air insufflation during balloon-assisted enteroscopy: A systematic review with meta-analysis.
abstract: Background and study aimsCarbon dioxide (CO2) insufflation has been suggested to be an ideal alternative to room air insufflation 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 CO2insufflation as compared to room air during BAE.Patients and methodsThe primary outcome is mean change in visual analog scale (VAS; 10 cm) at 1, 3, and 6 hours to assess pain. Secondary outcomes include insertion depth (anterograde or retrograde), adverse events, total enteroscopy rate, diagnostic yield, mean anesthetic dosage, and PaCO2at procedure completion. We searched MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception until May 2015. Multiple independent extractions were performed, the process was executed as per the standards of the Cochrane collaboration.ResultsFour randomized controlled trials (RCTs) were included in the meta-analysis. VAS at 6 hours favored CO2over room air (MD 0.13; 95 % CI 0.01, 0.25; p = 0.03). Anterograde insertion depth (cm) was improved in the CO2group (MD, 58.2; 95 % CI 17.17, 99.23; p = 0.005), with an improvement in total enteroscopy rate in the CO2group (RR 1.91; 95 % CI 1.20, 3.06; p = 0.007). Mean dose of propofol (mg) favored CO2compared to air (MD, - 70.53; 95 % CI - 115.07, - 25.98;P= 0.002). There were no differences in adverse events in either group.ConclusionsDespite the ability of CO2to improve insertion depth and decrease amount of anesthesia required, further randomized control trials are needed to determine the agent of choice for insufflation in balloon assisted enteroscopy.
authors.affiliation: Department of Internal Medicine, University of South Florida, Tampa, Florida, United States.
authors.forename: Ashok
authors.initials: A
authors.lastname: Shiani
authors.affiliation: Department of Digestive Diseases and Nutrition, University of South Florida, Tampa, Florida, United States.
authors.forename: Seth
authors.initials: S
authors.lastname: Lipka
authors.affiliation: Morsani College of Medicine Medical School, University of South Florida, Tampa, Florida, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, University of South Florida, Tampa, Florida, United States.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Rodriguez
authors.affiliation: Department of Digestive Diseases and Nutrition, University of South Florida, Tampa, Florida, United States.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Andrade
authors.affiliation: Department of Evidence Based Medicine, University of South Florida, Tampa, Florida, United States.
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Digestive Diseases and Nutrition, University of South Florida, Tampa, Florida, United States.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brady