Table 1. Summary of Findings.
| Quality assessment | No of patients | Effect | Quality | ||||||||
| No of studies | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Carbon dioxide insufflation | Room air insufflation | Relative(95 % CI) | Absolute | |
| Mean VAS at 1 hour (Better indicated by lower values) | |||||||||||
| 4 | randomized trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | none | 230 | 231 | – | MD 0.1 points higher (0.14 to 0.34) | ⊕⊕⊕ΟMODERATE |
| Mean VAS at 3 hours (Better indicated by lower values) | |||||||||||
| 4 | randomized trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | none | 230 | 231 | – | MD 0.06 points lower (0.41 to 0.29) | ⊕⊕⊕ΟMODERATE |
| Mean VAS at 6 hours (Better indicated by lower values) | |||||||||||
| 4 | randomized trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | none | 230 | 231 | – | MD 0.13 points higher (0.01 to 0.25) | ⊕⊕⊕ΟMODERATE |
| Mean VAS at 24 hours (Better indicated by lower values) | |||||||||||
| 3 | randomized trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | none | 124 | 123 | – | MD 0.11 points higher (0.03 to 0.24) | ⊕⊕⊕ΟMODERATE |
| Insertion Depth – Anterograde (Better indicated by lower values) | |||||||||||
| 3 | randomized trials | serious1 | serious2 | no serious indirectness | serious3 | none | 210 | 211 | – | MD 58.20 cm higher (17.17 to 99.23) | ⊕ΟΟΟVERY LOW |
| Insertion Depth – Retrograde (Better indicated by lower values) | |||||||||||
| 3 | randomized trials | serious1 | serious4 | no serious indirectness | very serious3 | none | 210 | 211 | – | MD 22.54 cm higher (49.08 to 94.16) | ⊕ΟΟΟVERY LOW |
| Insertion Depth Overall (Better indicated by lower values) | |||||||||||
| 3 | randomized trials | serious1 | serious4 | no serious indirectness | serious3 | none | 120 | 127 | – | MD 22.96 cm higher (8.82 to 54.74) | ⊕ΟΟΟVERY LOW |
| Any adverse Events | |||||||||||
| 4 | randomized trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | none | 1 /230 (0.43 %) | 2 /231 (0.87 %) | RR 0.63 (0.08 to 4.98) | 3 fewer events per 1000 (8 to 34) | ⊕⊕⊕ΟMODERATE |
| Diagnostic Yield | |||||||||||
| 2 | randomized trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | reporting bias5 | 97 /158 (61.4 %) | 91 /163 (55.8 %) | RR 1.07 (0.8 to 1.43) | 39 more per 1000 (112 fewer to 240 more) | ⊕⊕ΟΟLOW |
| 60 % | 42 more per 1000 (120 fewer to 258 more) | ||||||||||
| Total Enteroscopy Rate | |||||||||||
| 2 | randomized trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | reporting bias5 | 39 /158 (24.7 %) | 21 /163 (12.9 %) | RR 1.91 (1.2 to 3.06) | 117 more per 1000 26 more to 265 more) | ⊕⊕ΟΟLOW |
| 10.6 % | 96 more per 1000 (21 more to 218 more) | ||||||||||
| Sedation – Propofol Dose, Oral DBE (Better indicated by lower values) | |||||||||||
| 2 | randomized trials | serious1 | no serious inconsistency | no serious indirectness | very serious3 | reporting bias5 | 100 | 107 | – | MD 70.53 mg lower (115.07 to 25.98) | ⊕ΟΟΟVERY LOW |
| Blood Gas – PaCO2 – Anterograde, After DBE (Better indicated by lower values) | |||||||||||
| 2 | randomized trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | reporting bias5 | 119 | 120 | – | MD 1.2 mmHg higher (0.25 to 2.66) | ⊕⊕ΟΟLOW |
1
Out of 4 RCTs, 2 reported method of randomization sequence generation. In one RCT by Domagk et al. while block randomization was used, it is unclear how it was implemented as the endoscopy assistant was responsible for the allocation of the patient to the treatment group.
2
Out of 3 trials, 2 reported statistically significant findings and one showed no difference.
3
The results were associated with wide confidence intervals.
4
The results were conflicting across all 3 studies
5
Out of 4 trials only 2 reported this outcome