The impact of abdominal compression devices on colonoscopy outcomes: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective

Colonoscopy is the gold standard method for colorectal cancer screening. Looping occurs in 91% of cases undergoing colonoscopy and can cause patient discomfort, prolonged cecal intubation time (CIT), and colon perforation. This meta-analysis investigates the impact of abdominal compression devices (ACD) on colonoscopy outcomes.

Methods

A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), retrieved by systematically searching: PubMed, EMBASE, WOS, SCOPUS, and Cochrane through February 2nd, 2023. Continuous and dichotomous outcomes were pooled using mean difference (MD) and risk ratio (RR) along with confidence interval (CI) using Revman. Our review protocol was prospectively published on PROSPERO with ID: CRD42023397344.

Results

We included eight RCTs with a total of 1,889 patients. ACD was effective to decrease CIT (MD: −2.15 with a 95% CI [−3.49, −0.80], p = .002), postural change (RR: 0.57 with 95% CI [0.49, 0.66], p = .00001), and VAS pain score (MD: −1.49 with 95% CI [−1.81, −1.17], p = .0001). However, there was no difference between ACD and control groups regarding manual compression (RR: 0.65 with 95% CI [0.42, 1.00], p = .05), complete colonoscopy rate (CCR) (RR: 1.01 with 95% CI [0.99, 1.04], p = .31), and cecal intubation length (CIL) (MD: −2.25 with 95% CI [−7.64, 3.14], p = .41).

Conclusion

ACD during colonoscopy may enhance patient comfort by reducing CIT, pain, and postural changes. Nevertheless, additional RCTs are necessary to validate these results and determine the most suitable approach to utilize ACD for colonoscopy.

Keywords:

• Colonoscopy
• abdominal compression devices
• cecal intubation time
• meta-analysis
• systematic review

Transparency

Declaration of funding

This paper was not funded.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

M.T.A. and B.A. conceived the idea. B.A. and M.T.A. designed the research workflow. B.A. and M.T.A. searched the databases. A.M., H.A., B.K., and M.A.E. screened the retrieved records, extracted relevant data, assessed the quality of evidence, and B.A. resolved the conflicts. M.T.A. and A.M. performed the analysis. M.A. and M.T.A. wrote the final manuscript. M.T.A. supervised the project. All authors have read and agreed to the final version of the manuscript.