Comparative evaluation of high-flow nasal oxygenation and conventional oxygen therapy in patients undergoing endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis of randomized clinical trials

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and fluoroscopy to diagnose and treat numerous pancreatic and biliary diseases. The advantage of high-flow nasal oxygenation (HFNO) over conventional low-flow oxygen is not adequately established. EVIDENCE ACQUISITION: Literature searches of EMBASE, PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were performed to identify randomized controlled trials (RCTs) comparing HFNO and conventional oxygen therapy (COT) for patients undergoing ERCP under sedation. The primary outcome was hypoxemia incidence. Secondary outcomes included the percentage of patients who required procedure interruption and/or airway maneuvers, the incidence of hypercarbia, and the lowest recorded SpO2 values during the procedure. A subgroup analysis of the primary outcome was conducted to evaluate perioperative risk based on age differences. EVIDENCE SYNTHESIS: We analyzed 581 patients from five RCTs: 291 in the HFNO group and 290 in the COT group. Our results demonstrated a significantly lower number of hypoxemic events (risk ratio 0.44, 95% CI [0.21, 0.92], P=0.03) and higher lowest mean values of SpO2 (mean difference [MD] 2.29, 95% CI [0.94, 3.64], P