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Fig 1.

Flow diagram of studies identified, included, and excluded.

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Table 1.

Characteristics of the included studies.

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Fig 2.

Results of quality assessment by Cochrane risk of bias.

a. each risk of bias item presented as percentages across all included studies. b. each risk of bias item for each included study.

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Fig 3.

Forest plot of primary outcomes of ESD with CO2 insufflation and air insufflation.

A: post-procedural abdominal pain VAS score; SMD with 95% CI; B: Percentage of patients without pain; RR with 95% CI; C: mean PtcCO2 levels; SMD with 95% CI; D: post-procedural PaCO2; SMD with 95% CI.

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Fig 4.

Forest plot of secondary outcomes with CO2 insufflation group and air insufflation for ESD.

A: post-procedural abdominal distention VAS score; SMD with 95%CI; B: Change in abdominal circumference; SMD with 95%CI; C: post-procedural SpO2% levels; SMD with 95%CI; D: Procedure time; SMD with 95%CI; E: hospital stay; SMD with 95%CI; F: the incidence of Perforation; RR with 95%CI; G: the incidence of Haemorrhage; RR with 95%CI; H: the incidence of Pneumonia; RR with 95%CI; I: the incidence of Emphysema; RR with 95%CI; J: the mean count of white ball cell(WBC) on the day after ESD; SMD with 95%CI; K: the mean serum C-reactive protein (CRP) level on Day 3 after ESD; SMD with 95%CI; L: the midazolam dosage; SMD with 95%CI; M: the propofol dosage; SMD with 95%CI; N: the morphia dosage: SMD with 95%CI; O: redidual gas; MD with 95%CI; P: the incidence of dysphagia; OR with 95%CI.

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Table 2.

Changes in the heterogeneity of abdominal pain VAS score at 1h post-procedure after sequential exclusion of one study at a time.

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Table 3.

Changes in the heterogeneity of abdominal pain VAS score at 24h post-procedure after sequential exclusion of one study at a time.

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