Comparative Efficacy and Safety of Insufflation Methods in Enteroscopy: A Systematic Review and Network Meta-Analysis

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Device-associated enteroscopy, including double and single balloon enteroscopy , has transformed small bowel diagnostics and therapy. Optimal bowel insufflation is crucial for clear visualization. Traditional air insufflation causes bowel distension and discomfort. Alternatives like CO2, which is absorbed quickly, and water-exchange techniques, which reduce bowel loop formation, are explored for better outcomes. Our review evaluates the efficacy and safety of CO2, water, and air insufflation. Methods: Our systematic review and network meta-analysis covered 4 databases: Embase, Medline, Cochrane, and Scopus, evaluating insufflation methods in enteroscopy. Using Covidence, results were screened via PICO criteria, identifying 6 randomized trials. Data extraction included study and patient characteristics, and outcomes. Bias was assessed with RoB 2. Statistical analysis in R language software used the 'netmeta' package, calculating mean differences and risk ratios with 95% CIs, creating network plots, and ranking techniques via SUCRA curves and P-scores. Results: This analysis involves 6 studies with a total of 615 patients and 617 enteroscopies. No significant differences in oral intubation depth were found between Air and Water insufflation compared to CO2 (Air: MD -51.44, P = 0.138; Water: MD 48.3, P = 0.34). Similarly, in anal intubation, no significant differences were observed (Air: MD -31.47, P = 0.57; Water: MD -8.80, P = 0.91). In the combined oral and anal intubation, neither Air nor Water showed statistically significant differences compared to CO2 (Air: MD -58.31, P = 0.33. Water: MD -12.73, P = 0.81). Air led to a significantly longer anal procedure time compared to CO2 (MD 42.1, P < 0.0001), while Water did not differ (MD 10.3, P = 0.76). Water had a longer oral procedure time compared to CO2 (MD 14.40, P = 0.001), while whereas Air showed no statistically significant difference (MD 1.20, P = 0.12). Regarding the total endoscopy rate, Water was associated with a significantly higher rate of successful endoscopy compared to CO2, while Air showed a significantly lower rate. No significant differences in adverse events were found. Conclusion: Our analysis found no significant differences in intubation depth among CO2, Air, and Water insufflation. CO2 resulted in shorter procedure times, while Water showed a higher success rate for endoscopy. No significant disparities in adverse events were observed among the techniques.

Volume

119

Issue

10

First Page

S612

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