Baniya Ramkaji, Upadhaya Sunil, Khan Jahangir, Subedi Suresh K, Mohammed Tabrez S, Ganatra Balvant K, Bachuwa Ghassan
Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, USA.
Clin Endosc. 2017 Sep;50(5):464-472. doi: 10.5946/ce.2016.161. Epub 2017 May 18.
BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) with air insufflation is commonly used for the staging and treatment of early gastric carcinoma. However, carbon dioxide (CO) 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 CO and air insufflation in ESD.
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.
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; =0.020). However, no significant differences were found in the length of procedure, end-tidal CO, rate of perforation, and postprocedural hemorrhage between the two groups. The incidence of overall adverse events was significantly lower in the CO group (OR, 0.51; CI, 0.32-0.84; =0.007).
CO 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.
背景/目的：内镜下黏膜剥离术（ESD）联合空气注入常用于早期胃癌的分期和治疗。然而，已证明使用二氧化碳（CO₂）可减少术后疼痛和不良事件。本研究的目的是比较ESD中CO₂和空气注入相关的术后疼痛和不良事件。
对比较ESD中两种方法的随机对照试验（RCT）进行系统检索。采用Mantel-Haenszel方法分析数据。分别使用均值差（MD）和比值比（OR）分析连续变量和分类变量。
四项RCT共纳入391例行ESD的患者，纳入我们的荟萃分析。两组术后最大疼痛差异有统计学意义（MD，-7.41；95%置信区间[CI]，-13.6 - -1.21；P = 0.020）。然而，两组在手术时长、呼气末CO₂、穿孔率和术后出血方面未发现显著差异。CO₂组总体不良事件发生率显著较低（OR，0.51；CI，0.32 - 0.84；P = 0.007）。
与空气注入相比，胃ESD中CO₂注入与术后疼痛和不适较少以及总体不良事件风险较低相关。
