Purpose Hypoxemia remains a major complication during bronchoscopic procedures. This systematic review and meta-analysis is to systematically evaluate the efficacy and safety of supraglottic jet oxygenation and ventilation (SJOV) in preventing hypoxemia and improving clinical outcomes during bronchoscopy procedures. Methods Databases including Embase, MEDLINE, PubMed, Cochrane Library, Weipu, SinoMed, Wanfang Data and China National Knowledge Infrastructure were searched for randomized studies comparing SJOV with other conventional oxygen therapy in adult patients undergoing diagnostic or therapeutic bronchoscopy. The primary outcome was the incidence of hypoxic events. Secondary outcomes included the need for airway assistance, arteria blood gas, peri-operative adverse events. Results A total of 1,090 records were screened, and 10 RCTs involving 1,109 patients (555 in the SJOV group, 554 in the control group) were included, all conducted in China. SJOV significantly reduced the incidence of hypoxemia (OR = 0.20, 95%CI 0.07–0.58, I 2 = 80%), improved mean intraoperative oxygen saturation (SpO₂) (2.27, 0.12–4.42, 99%) and arterial oxygen partial pressure (PaO₂) compared with control group (36.31, 6.16–66.46, 99%). SJOV substantially reduced the need for jaw lift (0.09, 0.03–0.30, 79%), adjustment of ventilator parameters (0.05, 0.03–0.12, 45%), and mask ventilation with positive pressure (0.04, 0.01–0.12, 0%). SJOV was associated with a higher incidence of post-procedural xerostomia (6.08, 2.99–12.36, 44%) and sore throat (1.71, 1.08–2.71, 0.00), but no significant difference in nasal bleeding (0.70, 0.39–1.25, 0%). Intraoperatively, SJOV showed lower tachycardia (0.35, 0.14–0.91,15%) and reduced hypertension incidence (OR = 0.20, 0.06–0.70, 45%). Conclusion SJOV significantly improves oxygenation, reduces hypoxemia and rescue interventions during bronchoscopy, with a manageable safety profile. It may be a valuable oxygenation strategy for bronchoscopic procedures, especially in high-risk patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251083408 .
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