Utility of high-flow nasal oxygen in comparison to conventional oxygen therapy during upper gastrointestinal endoscopic procedures under sedation: A systematic review and meta-analyses

• Published in: Indian journal of gastroenterology 2023-02, Vol.42 (1), p.53-63
• Main Authors: Khanna, Puneet, Haritha, Damarla, Das, Aditi, Sarkar, Soumya, Roy, Avishek
• Format: Article
• Language: English
• Subjects: Endoscopy, Gastrointestinal; Gastroenterology; Hepatology; Humans; Hypnotics and Sedatives; Hypoxia - epidemiology; Hypoxia - etiology; Hypoxia - prevention & control; Medicine; Medicine & Public Health; Original; Original Article; Oxygen; Oxygen Inhalation Therapy - adverse effects; Oxygen Inhalation Therapy - methods
• ISSN: 0254-8860; 0975-0711
• DOI: 10.1007/s12664-022-01308-6

Background Sedation and analgesia are the integral components of modern-day upper gastrointestinal (GI) endoscopic procedures. Irrespective of the sedative agent, hypoxia is the most commonly encountered unwarranted event with sedation. The current study intends to scrutinize whether high-flow nasal oxygen (HFNO) is advantageous for providing respiratory support during upper GI endoscopic procedures over other conventional low-flow oxygen delivery modalities, e.g. nasal cannula, facemask, etc. Methods An extensive screening of electronic databases was done till July 31, 2022, after enlisting in International prospective register of systematic reviews (PROSPERO) (CRD42021245409). Randomized controlled trials (RCT), comparative cohort studies, case series, cross-sectional studies and case–control studies evaluating the utility of HFNO during upper GI endoscopy under sedation were included in this meta-analysis. Results We retrieved eight randomized control studies and one longitudinal study with 3294 patients. The application of HFNO during endoscopy led to lesser incidence of desaturation spells (odds ratio [OR] = 0.23; 95% CI 0.11–0.48; I 2  = 71%), reduced procedural interruption (OR = 0.11; 95% CI 0.02–0.60; I 2  = 88%), better  nadir SpO 2 level during procedure (mean difference [MD] = 3.16; 95% CI 0.54–5.78; I 2  = 73%), overall lesser incidence of sedation-related adverse events (OR = 0.63; 95% CI 0.42–0.93; I 2  = 25%), with no significant impact on the duration of endoscopy (MD = 0.15; 95% CI − 0.02 to 0.31, I 2  = 0%). Conclusion HFNO is a novel option for upper GI endoscopy under sedation. Clinical trial number and registry URL CRD42021245409 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021245409 ).