Effects of Fasting versus Non-Fasting on Emetic Complications in Radiological Examinations Using Intravascular Non-Ionic Iodinated Contrast Media:A Systematic Review and Meta-Analysis

ABSTRACT

Objective@#To compare the incidence of aspiration pneumonia, nausea, and vomiting after intravascular administration of nonionic iodinated contrast media (ICM) between patients who fasted before contrast injection and those who did not. @*Materials and Methods@#Ovid-MEDLINE and Embase databases were searched from their inception dates until September 2022 to identify original articles that met the following criteria 1) randomized controlled trials or observational studies, 2) separate reports of the incidence of aspiration pneumonia, nausea, and vomiting after intravascular injection of non-ionic ICM, and 3) inclusion of patients undergoing radiological examinations without fasting. A bivariate beta-binomial model was used to compare the risk difference in adverse events between fasting and non-fasting groups. The I2 statistic was used to assess heterogeneity across the studies. @*Results@#Ten studies, encompassing 308013 patients (non-fasting, 158442), were included in this meta-analysis. No cases of aspiration pneumonia were reported. The pooled incidence of nausea was 4.6% (95% confidence interval [CI] 1.4%, 7.8%) in the fasting group and 4.6% (95% CI 1.1%, 8.1%) in the non-fasting group. The pooled incidence of vomiting was 2.1% (95% CI 0.0%, 4.2%) in the fasting group and 2.5% (95% CI 0.7%, 4.2%) in the non-fasting group. The risk difference (incidence in the non-fasting group–incidence in the fasting group) in the incidence of nausea and vomiting was 0.0% (95% CI -4.7%, 4.7%) and 0.4% (95% CI -2.3%, 3.1%), respectively. Heterogeneity between the studies was low (I2 = 0%–13.5%). @*Conclusion@#Lack of fasting before intravascular administration of non-ionic ICM for radiological examinations did not increase the risk of emetic complications significantly. This finding suggests that hospitals can relax fasting policies without compromising patient safety.