Non-pharmacological techniques complementary to sedation administration decrease pain and anxiety during gastrointestinal endoscopic procedures: a meta-analysis

Philip Roelandt; Georgios Tziatzios; Nick De Leebeeck; Konstantinos Triantafyllou

Authors Philip Roelandt, Georgios Tziatzios, Nick De Leebeeck, Konstantinos Triantafyllou.

Abstract

Background We performed a meta-analysis to assess the effect of non-pharmacological techniques, such as virtual reality (VR) and music, as adjuncts to sedation administration during gastrointestinal (GI) endoscopic procedures.

Methods We performed a systematic review across MEDLINE and Cochrane Central Register libraries of randomized controlled trials (RCTs), published between 2014 and 2024, evaluating how non-pharmacological techniques affected patients’ reported pain (primary outcome), an anxiety and satisfaction (secondary outcomes), during endoscopy. We performed pairwise metaanalyses and expressed the effect size on study outcomes. We assessed the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation approach.

Results Twelve RCTs analyzing outcomes from 1511 patients (non-pharmacological techniques n=762; standard sedation n=749) were included. Compared to the sedation-only group, application of non-pharmacological techniques resulted overall in significantly lower pain as mean difference [MD] -1.02, 95% confidence interval [CI] -1.64 to -0.41; Ι2=64%) and anxiety (MD -1.07, 95%CI -1.75 to -0.39; Ι2=20%), with higher satisfaction (MD 1.67, 95%CI 0.50-2.84; Ι2=94%). There was low confidence in the estimates, due to the possibility of performance and detection bias in the majority of the studies, and the high level of heterogeneity. This effect regarding reported
pain was consistent for virtual reality (3 RCTs, n=241) and music (10 RCTs, n=1270): MD -1.05, 95%CI -1.74 to -0.37; I2=0%, and MD -1.00, 95%CI -1.80 to -0.20; I2=73%, respectively.

Conclusion Concomitant application of virtual reality and/or music as adjuncts to sedation administration during GI endoscopic procedures decreases pain and anxiety, at the same improving time patient satisfaction.

Keywords Music, virtual reality, non-pharmacological, endoscopy, pain

Ann Gastroenterol 2025; 38 (6): 709-719