Abdominal binders improve colonoscopy outcomes: a systematic review and meta-analysis of randomized controlled trials with BMI-stratified subgroup analysis
In brief
Abdominal binders shave 1.6 minutes off colonoscopy time and halve manual pressure
A meta-analysis of 14 randomized trials (2,834 patients) found that using an abdominal binder reduced cecal intubation time by roughly 1.6 minutes, lowered patient pain, and cut the need for manual pressure by about half, with similar benefits in very lean and obese patients. The benefit was less clear in those with mid-range BMI, so targeted trials are needed to confirm the pattern.
- Journal
- Therapeutic advances in gastroenterology (Q1)
- Published
- 20 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yu-Kuang Kang, Tien-Yu Huang, Meng-Chuan Lu, Peng-Jen Chen, Po-Feng Huang
- PMID
- 42483092
- DOI
- 10.1177/17562848261466908
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 26 July 2026): High-quality evidence in a top journal
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 26 July 2026).
- Picked for Gastroenterology (top studies of the week, 26 July 2026).
Abstract
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).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.