European Journal of Medical Research (Apr 2025)

Comparison of intratracheal intubation or not during endoscopic retrograde cholangiopancreatography: a meta-analysis and systematic review

  • Binfeng Zhang,
  • Zekun Lang,
  • Lei Zhang,
  • Boxiong Gao,
  • Yutong Wang,
  • Yatao Liu

DOI
https://doi.org/10.1186/s40001-025-02558-8
Journal volume & issue
Vol. 30, no. 1
pp. 1 – 8

Abstract

Read online

Abstract Objectives In endoscopic retrograde cholangiopancreatography anesthesia, both intubation and non-intubation techniques have their own advantages and disadvantages. However, whether either approach is associated with postoperative and anesthesia-related adverse events remains controversial. Methods We searched the literature in PubMed, Web of Science, Cochrane Library, Scopus, Ovid and Embase databases up to October 2024. All studies comparing intubated vs. non-intubation anesthesia for endoscopic retrograde cholangiopancreatography were included. The main outcome measures were sedation-related adverse events and death. Data were combined using risk ratio with 95% confidence intervals. The study protocol was prospectively registered with PROSPERO (CRD42024608807). Results We finally included 8 studies with a total of 21,433 patients. Endotracheal intubation was associated with a lower risk of sedation-related adverse events (RR: 2.85, 95% CI 1.33–6.09, p = 0.007). However, the risks of death (RR: 0.59, 95% CI 0.36–0.96, p = 0.03) and intraoperative hypotension (RR: 0.43, 95% CI 0.26–0.69, p = 0.0006) were lower without intubation. In the trial-sequence analysis, the trial-sequence monitoring boundary is crossed, indicating conclusive evidence of a statistically significant effect. Conclusions Our findings suggest that endotracheal intubation during endoscopic retrograde cholangiopancreatography is associated with a lower risk of sedation-related adverse events but a higher risk of mortality and intraoperative hypotension compared to non-intubation. However, these associations do not establish direct causality and should be interpreted with caution. Further high-quality randomized controlled trials are needed to validate these findings. Clinicians should adopt a patient-centered approach, carefully balancing the potential benefits and risks of intubation to optimize airway management strategies in endoscopic retrograde cholangiopancreatography.

Keywords