Efficacy of Musculoskeletal Manipulation for Endoscopic Discomfort in Patients Undergoing Upper Gastrointestinal Endoscopy and Colonoscopy: A Systematic Review and Meta-Analysis.

Patients undergoing upper gastrointestinal endoscopy (UGIE) and colonoscopy often experience discomfort, including anxiety, abdominal pain, and bloating. The efficacy of musculoskeletal manipulation (e.g., massage) for these symptoms remains unclear. This systematic review and meta-analysis aimed to clarify its efficacy in patients undergoing UGIE and colonoscopy. We searched major electronic databases (MEDLINE (PubMed), CENTRAL, EMBASE, CINAHL, and PEDro) and trial registries up to July 17, 2025, for randomized controlled trials (RCTs). Meta-analyses employed a random-effects model, and risk of bias was formally assessed. Four trials were included. Two trials on reflexology showed a non-significant effect on pre-procedural anxiety, with the evidence being highly variable and leading to very low certainty findings. Two trials on abdominal massage following colonoscopy suggested a possible benefit for reduced abdominal pain, but this finding was limited by substantial heterogeneity. The overall evidence for musculoskeletal manipulation on anxiety, abdominal pain, and bloating is generally low or very low certainty due to imprecision and high risk of bias. While the overall evidence is insufficient for routine clinical recommendations, future high-quality, large-scale trials that standardize outcome assessments are essential to establish definitive conclusions. This review was registered with PROSPERO (CRD420251104522).