Comparative analysis of supraglottic airway vs. infraglottic airway in endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis.

Aim: To compare the efficacy and safety of supraglottic airway (SGA) vs. infraglottic airway (IGA) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).

Background: To optimize patient outcomes by improving airway control, various airway techniques have been employed for sedation during ERCP. However, there is uncertainty about the noninferiority of SGA devices compared to IGA.

Methods: We performed a systematic review in PubMed, Embase, and Cochrane Library databases, searching for randomized and non-randomized studies comparing SGA vs. IGA in patients undergoing ERCP and reporting at least one of the outcomes of interest. The primary outcomes were procedure time, incidence of hypoxia, and blood staining events. Statistical analyses were performed using R language 4.3.1. Odds ratio (OR) was used for binary outcomes and mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI). Heterogeneity was assessed using the Cochran Q test and I² statistics.

Results: The study comprised 1 randomized controlled trial (RCT) and 3 observational studies involving 280 patients. Among them, 160 were allocated to the SGA group and 120 to the IGA group. When comparing procedure times, there was no statistically significant difference between SGA and IGA (MD -1.51 minutes; 95% CI -6.10 to 3.09 minutes; p = 0.52; I² = 62%). Regarding blood staining, statistical significance favored IGA over SGA (OR 2.67; 95% CI 1.12 to 6.41, p = 0.027; I² = 0%).

Conclusion: No statistically significant difference in procedure time was observed between SGA and IGA. However, IGA exhibited a favorable outcome regarding reduced blood staining compared to SGA. Further studies comparing similar outcomes are necessary to assess such associations better.