{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T09:02:09Z","timestamp":1784710929095,"version":"3.55.0"},"reference-count":42,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therap Adv Gastroenterol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <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>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <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>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis of randomized controlled trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      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\u2013Laird) models: mean difference (CIT), Hedges\u2019s\n                      <jats:italic toggle=\"yes\">g<\/jats:italic>\n                      (pain), and risk ratio (manual pressure, position change). BMI was a pre-specified stratified subgroup across three study-level tertiles (&lt;26, 26\u201328, &gt;28\u2009kg\/m\u00b2); robustness was assessed by leave-one-out sensitivity analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Fourteen RCTs (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20092834) were included after two post hoc exclusions (predatory publication; unverifiable randomization). Abdominal binders significantly reduced CIT (MD \u22121.576\u2009min;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      \u2009=\u200914), pain (Hedges\u2019s\n                      <jats:italic toggle=\"yes\">g<\/jats:italic>\n                      \u22120.853;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      \u2009=\u20098), manual pressure (RR 0.522;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      \u2009=\u200911), and position change (RR 0.569;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      \u2009=\u200911). 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 (&lt;26) and obese (&gt;28) strata showed benefit while the intermediate stratum (26\u201328) did not. Position-change benefit reached significance only in the lean stratum. Effects were robust on leave-one-out.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <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>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <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>\n                  <\/jats:sec>","DOI":"10.1177\/17562848261466908","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:16:47Z","timestamp":1784542607000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Abdominal binders improve colonoscopy outcomes: a systematic review and meta-analysis of randomized controlled trials with BMI-stratified subgroup analysis"],"prefix":"10.1177","volume":"19","author":[{"given":"Yu-Kuang","family":"Kang","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tien-Yu","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Chuan","family":"Lu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3918-4540","authenticated-orcid":false,"given":"Po-Feng","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City 114202, Taiwan"},{"name":"Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2015.418"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.12.039"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.11.026"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2007.03.032"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.14077"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1443-1661.2011.01207.x"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9010011"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.5946\/ce.2022.304"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/jgh3.12276"},{"key":"e_1_3_4_11_2","first-page":"96","article-title":"Optimizing colonoscopy with abdominal compression devices: an updated meta-analysis of randomized controlled trials","volume":"39","author":"Abdallfatah A","year":"2026","unstructured":"Abdallfatah A, Aldemerdash MA, Hageen AW, et al. 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