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Abdominal binders improve colonoscopy outcomes: a systematic review and meta-analysis of randomized controlled trials with BMI-stratified subgroup analysis
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DOI：10.1177/17562848261466908.png)
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Abstract
En 中文
<jats:sec>
<jats:title>Background:</jats:title>
<jats:p>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.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Objectives:</jats:title>
<jats:p>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.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Design:</jats:title>
<jats:p>Systematic review and meta-analysis of randomized controlled trials.</jats:p>
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<jats:title>Methods:</jats:title>
<jats:p>
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
<jats:italic toggle="yes">g</jats:italic>
(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.
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<jats:title>Results:</jats:title>
<jats:p>
Fourteen RCTs (
<jats:italic toggle="yes">n</jats:italic>
= 2834) were included after two post hoc exclusions (predatory publication; unverifiable randomization). Abdominal binders significantly reduced CIT (MD −1.576 min;
<jats:italic toggle="yes">p</jats:italic>
< 0.001;
<jats:italic toggle="yes">k</jats:italic>
= 14), pain (Hedges’s
<jats:italic toggle="yes">g</jats:italic>
−0.853;
<jats:italic toggle="yes">p</jats:italic>
< 0.001;
<jats:italic toggle="yes">k</jats:italic>
= 8), manual pressure (RR 0.522;
<jats:italic toggle="yes">p</jats:italic>
< 0.001;
<jats:italic toggle="yes">k</jats:italic>
= 11), and position change (RR 0.569;
<jats:italic toggle="yes">p</jats:italic>
< 0.001;
<jats:italic toggle="yes">k</jats:italic>
= 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.
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<jats:sec>
<jats:title>Conclusion:</jats:title>
<jats:p>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.</jats:p>
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<jats:title>Trial registration:</jats:title>
<jats:p>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).</jats:p>
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