Clinical Endoscopy

Jahangir Khan

1 Article

Carbon Dioxide versus Air Insufflation in Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Ramkaji Baniya, Sunil Upadhaya, Jahangir Khan, Suresh K Subedi, Tabrez S Mohammed, Balvant K Ganatra, Ghassan Bachuwa; Clin Endosc 2017;50(5):464-472. Published online May 18, 2017; DOI: https://doi.org/10.5946/ce.2016.161

Background
/Aims: Endoscopic submucosal dissection (ESD) with air insufflation is commonly used for the staging and treatment of early gastric carcinoma. However, carbon dioxide (CO₂) use has been shown to cause less post-procedural pain and fewer adverse events. The objective of this study was to compare the post-procedural pain and adverse events associated with CO₂ and air insufflation in ESD.
Methods
A systematic search was conducted for randomized control trials (RCTs) comparing the two approaches in ESD. The Mantel-Haenszel method was used to analyze the data. The mean difference (MD) and odds ratio (OR) were used for continuous and categorical variables, respectively.
Results
Four RCTs with a total of 391 patients who underwent ESD were included in our meta-analysis. The difference in maximal post-procedural pain between the two groups was statistically significant (MD, -7.41; 95% confidence interval [CI], -13.6 – -1.21; p=0.020). However, no significant differences were found in the length of procedure, end-tidal CO₂, rate of perforation, and postprocedural hemorrhage between the two groups. The incidence of overall adverse events was significantly lower in the CO₂ group (OR, 0.51; CI, 0.32–0.84; p=0.007).
Conclusions
CO₂ insufflation in gastric ESD is associated with less post-operative pain and discomfort, and a lower risk of overall adverse events compared with air insufflation.

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