Clin Endosc.  2021 Mar;54(2):242-249. 10.5946/ce.2020.275.

Insufflation of Carbon Dioxide versus Air During Colonoscopy Among Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Guacho JAL
• Moura DTHd
• Ribeiro IB
• Moura BFBHD
• Gallegos MMM
• McCarty T
• Toma RK
• Moura EGHd

• KMID: 2514179
• DOI: http://doi.org/10.5946/ce.2020.275

Abstract

Background/Aims
Carbon dioxide is increasingly used in insufflation during colonoscopy in adult patients; however, air insufflation remains the primary practice among pediatric gastroenterologists. This systematic review and meta-analysis aims to evaluate insufflation using CO₂ versus air in colonoscopies in pediatric patients.
Methods
Individualized search strategies were performed using MEDLINE, Cochrane Library, EMBASE, and LILACS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane working methodology. Randomized control trials (RCTs) were selected for the present meta-analysis. Pooled proportions were calculated for outcomes including procedure time and abdominal pain immediately and 24 hours post-procedure.
Results
The initial search yielded 644 records, of which five RCTs with a total of 358 patients (CO₂: n=178 versus air: n=180) were included in the final analysis. The procedure time was not different between the CO₂ and air insufflation groups (mean difference, 10.84; 95% confidence interval [CI], -2.55 to 24.22; p=0.11). Abdominal pain immediately post-procedure was significantly lower in the CO₂ group (risk difference, -0.15; 95% CI; -0.26 to -0.03; p=0.01) while abdominal pain at 24 hours post-procedure was similar (risk difference, -0.05; 95% CI; -0.11 to 0.01; p=0.11).
Conclusions
Based on this systematic review and meta-analysis of RCT data, CO₂ insufflation reduced abdominal pain immediately following the procedure, while pain was similar at 24 hours post-procedure. These results suggest that CO₂ is a preferred insufflation technique when performing colonoscopy in pediatric patients.

Keyword

Carbon dioxide; Air; Colonoscopy; Pediatric; Meta-analysis

Figure

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  Fig. 1. Flow diagram of the analyzed studies.

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  Fig. 2. Forest plot comparing the time of the colonoscopy procedure, using CO2 insufflation versus air insufflation in pediatric patients. CI, confidence interval; IV, instrumental variable; SD, standard deviation.

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  Fig. 3. (A) Forest plot comparing abdominal pain immediately post-procedure using CO2 insufflation versus air insufflation in pediatric patients. (B) Forest plot comparing abdominal pain at 24 hours after the procedure, using CO2 insufflation versus air insufflation in pediatric patients. CI, confidence interva.

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