Noninvasive positive airway pressure for hypoxemia prevention during sedated gastrointestinal endoscopy in adults with obesity: a systematic review and meta-analysis
In brief
Nasal CPAP cuts oxygen desaturation risk by three quarters during sedated endoscopy in obese adults
A meta-analysis of four randomized trials (457 patients) found that nasal CPAP or non-invasive ventilation lowered the chance of SpO₂ dropping below 90% to about one-quarter of that with standard oxygen. Rescue airway maneuvers were also less frequent, but the evidence is very low certainty and larger, standardized studies are needed.
- Journal
- Gastrointestinal endoscopy (Q1)
- Published
- 1 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jariel Abreu Pérez, Valeria Esther Acosta Casana, Carlos Josue Alfaro Lazo, Valentina Alonzo, Carla Daniela Calizaya Baldellon, Alejandro Chen Liang, et al.
- PMID
- 42679863
- DOI
- 10.1016/j.gie.2026.08.037
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 6 September 2026): Positive airway pressure for endoscopy, not imaging oncology
- Picked for Gastroenterology (paper of the day, 3 September 2026): Meta‑analysis of CPAP/NIPPV for hypoxemia prevention during sedated GI endoscopy
Abstract
BACKGROUND AND AIMS: Adults with obesity undergoing gastrointestinal endoscopy under sedation are at increased risk of hypoxemia. We evaluated nasal continuous positive airway pressure (nCPAP) and noninvasive positive pressure ventilation (NIPPV) versus conventional oxygen therapy in this population. METHODS: We searched six databases from inception through May 2026 for randomized controlled trials evaluating nCPAP or NIPPV in adults with obesity undergoing gastrointestinal endoscopy. The review followed PRISMA guidelines and was registered in PROSPERO (CRD420261391143). The primary outcome was oxygen desaturation, defined as SpO2 <90% or ≤90% according to study definitions. Rescue airway maneuvers were secondary. Random-effects meta-analysis, trial sequential analysis, and GRADE were performed. RESULTS: Four RCTs comprising 457 participants were included. Positive airway pressure strategies reduced oxygen desaturation (RR 0.27; 95% CI 0.14-0.53; p<0.01; I2=0%), with moderate-certainty evidence. Rescue airway maneuvers were also reduced (RR 0.45; 95% CI 0.23-0.89; p=0.03; I2=46.5%); however, certainty was very low, and the prediction interval included no effect. Trial sequential analysis crossed the monitoring boundaries for benefit for both outcomes. Oxygen-delivery protocols differed across trials, and effective FiO2 was not directly measured. CONCLUSIONS: NCPAP or NIPPV may reduce oxygen desaturation during sedated gastrointestinal endoscopy in adults with obesity. The effect on rescue airway maneuvers remains uncertain. Larger trials using standardized oxygen-delivery and airway-rescue protocols are warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.