Total Colonic Decompression After Colonoscopy for the Prevention of Post-colonoscopy Abdominal Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Post-colonoscopy abdominal pain and bloating are common adverse events associated with residual intraluminal air.Total colonic decompression (TCD), involving reintubation of the colonoscope to the cecum followed by active air aspiration during withdrawal, has been proposed to alleviate these symptoms; however, evidence regarding its clinical effectiveness remains inconsistent.This systematic review and meta-analysis evaluated the efficacy and safety of TCD compared with standard colonoscopy withdrawal.PubMed, Scopus, and Web of Science were systematically searched from inception through September 2026 for randomized controlled trials evaluating TCD versus standard withdrawal in adults undergoing colonoscopy with room-air insufflation.The primary outcomes were the incidence and severity of early and 24-hour post-colonoscopy abdominal pain.Risk ratios and mean differences with 95% confidence intervals were pooled using random-effects models.The protocol was registered in PROSPERO (CRD420261505215).Four randomized controlled trials involving 1,037 participants were included.TCD reduced the incidence of early post-colonoscopy abdominal pain compared with standard withdrawal, whereas no statistically significant reduction was observed in early pain severity.Similarly, TCD did not demonstrate a statistically significant reduction in either the incidence or severity of post-colonoscopy abdominal pain at 24 hours.Overall, total colonic decompression may reduce the occurrence of early post-colonoscopy abdominal pain but does not appear to provide a sustained reduction in pain severity.Further randomized controlled trials using standardized decompression techniques and consistent outcome assessment are warranted to clarify its clinical utility.