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Abdominal binders improve colonoscopy outcomes: a systematic review and meta-analysis of randomized controlled trials
Yu-Kuang Kang1, Tien-Yu Huang1, Meng-Chuan Lu1
1Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan.
Background:
Abdominal binders have been studied as an adjunctive device for colonoscopy, but trial-level evidence is heterogeneous and existing meta-analyses have either not stratified by body-mass index (BMI) or used only linear meta-regression, leaving BMI dependence of binder benefit unresolved.
Objectives:
To quantify the effect of abdominal binders on cecal intubation time (CIT), post-procedural pain, manual pressure, and position change during adult colonoscopy and to examine BMI dependence using a pre-specified stratified approach.
Design:
Systematic review and meta-analysis of randomized controlled trials.
Methods:
Seven academic databases plus ClinicalTrials.gov were searched (primary April 30, 2025; updated February 28, 2026). Two reviewers screened records and assessed risk of bias (Cochrane RoB 2) independently. Effects were pooled with random-effects (DerSimonian-Laird) models: mean difference (CIT), Hedges's g (pain), and risk ratio (manual pressure, position change). BMI was a pre-specified stratified subgroup across three study-level tertiles (<26, 26-28, >28 kg/m²); robustness was assessed by leave-one-out sensitivity analyses.
Results:
Fourteen RCTs (n = 2834) were included after two post hoc exclusions (predatory publication; unverifiable randomization). Abdominal binders significantly reduced CIT (MD -1.576 min; p < 0.001; k = 14), pain (Hedges's g -0.853; p < 0.001; k = 8), manual pressure (RR 0.522; p < 0.001; k = 11), and position change (RR 0.569; p < 0.001; k = 11). BMI-stratified analysis revealed a non-monotonic pattern for CIT and manual pressure (with a parallel pattern for pain whose intermediate stratum rests on a single trial): lean (<26) and obese (>28) strata showed benefit while the intermediate stratum (26-28) did not. Position-change benefit reached significance only in the lean stratum. Effects were robust on leave-one-out.
Conclusion:
Abdominal binders consistently improve four colonoscopy-related outcomes; the non-monotonic BMI response pattern suggests two distinct mechanistic pathways and is hypothesis-generating, warranting confirmation in BMI-stratified randomized trials.
Trial Registration:
Prospectively registered with International Platform of Registered Systematic Review and Meta-Analysis Protocols on May 15, 2025 (registration number INPLASY202550043; DOI: 10.37766/inplasy2025.5.0043).
