| Objective: To assess the safety and efficacy of carbon dioxide(CO2)insufflation during upper gastrointestinal endoscopic submucosal dissection through Meta-Analysis of collected randomized controlled trials,both at home and abroad,on carbon dioxide insufflation during upper gastrointestinal endoscopic submucosal dissection.Methods: The literature of clinical studies related on carbon dioxide insufflation during upper gastrointestinal endoscopic submucosal dissection was selected by searching several national and international databases including PubMed?MEDLINE?Embase?CENTRAL?EBSCO?OVID?WANFANG?VIP?CNKI ?CBM.Researchers manually searched relevant references on journals of digestive endoscopy.The date of the search ends in January 2017.two researchers independently screened the eligible studies which based on the inclusion and exclusion criteria.If the two views are not unified,the third participants take part in to determine the final inclusion literatures.The modified Jada scale was adopted to assess methodological quality of included articles.Extracting data and using Rev Man 5.3 for Meta-Analysis,the odds ratio(OR)with 95%confidence interval(CI)for dichotomous data,and the standard mean difference(SMD)with 95% CI for continuous data.Results: 116 articles were retrieved,after screening,9 articles were included.Among them,5 English literatures and 4 Chinese literatures.A total of 771 patients were included in the study,including CO2 group(n = 389)and air group(n = 382).There was no significant difference between CO2 group and air group in complete resection rate[OR=1.32,95%CI(0.38,4.59),P=0.66],Curative resection rate[OR=1.06,95%CI(0.33,3.42),P=0.92],en bloc resection rate,procedure time[OR=1.06,95%CI(0.33,3.42),P=0.92],hospital stay time [SMD=-0.24,95%CI(-0.64,-0.15),P=0.23],duration of fasting time after ESD[SMD=-0.20,95%CI(-1.52,1.13),P=0.77] on statistics.CO2 group compared with air group could significantly reduce the gas volume in the gastrointestinal tract after ESD [SMD=-0.86,95%CI(-1.20,-0.52),P<0.00001],shorten the emphysema fading away time [SMD=-1.05,95%CI(-1.54,-0.55,P<0.0001]);CO2 group compared with air group could lead to a significant decrease in post-ESD abdominal pain at 6 hour[SMD=-0.56,95%CI(-0.86,-0.27),P=0.0002] and the next day [SMD=-0.98,95%CI(-1.51,-0.44),P=0.0004] on statistics,respectively.However,the benefit disappeared at 1hours[SMD=0.10,95%CI(-0.49,0.69),P=0.74] and 3 hour [SMD=-0.06,95%CI(-0.60,0.48),P=0.83].CO2 group compared with air group could lead to a significant increase in post-ESD abdominal pain free patients for the next day[OR=2.9,95%CI(1.43,5.87),P=0.003] on statistics,but the benefit disappeared at 1hour[OR=2.27,95%CI(0.37,14.01),P=0.38] and 3hour[OR=1.17,95%CI(0.26,5.25),P=0.84].CO2 insufflation led to a significant decrease in post-ESD abdominal distension compared with air insufflation at 3 hour[SMD=-0.44,95%CI(-0.77,-0.11),P=0.009] and the next day [SMD=-0.27,95%CI(-0.53,-0.01),P=0.04] on statistics,respectively.However,the benefit disappeared at 1hours[SMD=-0.96,95%CI(-3.34,-1.43),P=0.43].There was no significant difference between CO2 group and air group in Maximum PtcCO2[SMD=-0.05,95%CI(-0.35,0.25),P=0.75],PtcCO2 elevation [SMD=-0.10,95%CI(-0.72,0.53),P=0.76],Maximum EtCO2[SMD=-0.05,95%CI(-0.38,0.27),P=0.75],EtCO2 elevation [SMD=0.23,95%CI(-0.09,0.56),P=0.16],PCO2 after ESD [SMD=0.07,95%CI(-0.23,0.36),P=0.66],Minimum SpO2[SMD=0.13,95%CI(-0.09,0.35),P=0.25],SpO2 depression[SMD=-0.11,95%CI(-0.37,0.14),P=0.39] on statistics.For the occurrence of ESD related complications,CO2 insufflation led to a significant decrease compared with air insufflation in the incidence of emphysema [OR=0.52,95%CI(0.29,0.92),P=0.03] and Mallory-Weiss tears syndrome[P= 0.013] on statistics,respectively.However,the benefit disappeared at the incidence of perforation[OR=0.7,95%CI(0.32,1.53),P=0.37] and hemorrhage [OR=0.53,95%CI(0.25,1.14),P=0.10].There was no significant difference between the two groups in the occurrence of CO2 related complications on statistics,it was only 1 article reported 1 patients with paroxysmal atrial fibrillation(P=0.953)in CO2 group.Conclusion:It is safe and effective for CO2 insufflation during upper gastrointestinal endoscopic submucosal dissection.Which can significantly reduce post-ESD abdominal pain,abdominal distention,gas volume in the gastrointestinal tract,the incidence of ESD related complications,without CO2 retention.More large sample sizes and high quality studies are needed to confirm the conclusion. |
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