Effectiveness of Non-pharmacological Interventions for Reducing Anxiety in Endoscopy and Colonoscopy Procedures: A Systematic Review and Network Meta-Analysis

BACKGROUND: Anxiety is a common concern among patients undergoing endoscopic procedures, affecting up to 70% of individuals. Increased anxiety can heighten pain perception, reduce procedural tolerance, and negatively impact patient satisfaction. Non-pharmacological interventions, such as music therapy, virtual reality, aromatherapy, relaxation techniques, and others, have been explored as alternatives to pharmacological anxiolytics.. This systematic review and network meta-analysis (NMA) provides an evaluation of these interventions in reducing anxiety and their impact on secondary outcomes, including pain, patient satisfaction, and procedure duration. METHODS: Following PRISMA guidelines, we systematically searched seven databases for randomized controlled trials (RCTs) evaluating non-pharmacological interventions for anxiety reduction in endoscopy and colonoscopy. A network meta-analysis was conducted using a random-effects model to compare intervention effectiveness, with standardized mean differences (SMDs) and 95% confidence intervals (CIs) calculated. Surface under the cumulative ranking (SUCRA) probabilities determined the rank order of interventions. Subgroup analyses were performed by type of procedure (upper vs. lower endoscopy) and sedation status. RESULTS: A total of 48 RCTs comprising 6014 participants and evaluating 12 non-pharmacological interventions were included. In the network meta-analysis (NMA) for anxiety, Reiki (SMD = - 1.51, 95% CI - 3.01 to - 0.01, p = 0.04), aromatherapy (SMD = - 1.31, 95% CI - 2.47 to - 0.14, p = 0.02), and music therapy (SMD = - 1.09, 95% CI - 1.50 to - 0.67, p < 0.01) significantly reduced anxiety compared to standard care. These interventions also ranked highest in terms of SUCRA values Reiki (0.77), aromatherapy (0.73), and music therapy (0.67). The NMA for secondary outcomes showed that music therapy significantly improved patient satisfaction (SMD = 2.21, 95% CI 1.20 to 3.22, p < 0.01), while no intervention had a statistically significant impact on pain or procedure duration. Subgroup analyses showed that music therapy was most consistent in lower endoscopic and sedated procedures, while aromatherapy and Reiki demonstrated stronger effects in upper and non-sedated procedures. CONCLUSION: Music therapy demonstrated the strongest evidence for anxiety reduction, with potential benefits for patient satisfaction. Reiki and aromatherapy also ranked highly, though their significance varied. No intervention significantly influenced pain or procedure duration. Subgroup analyses suggested that effectiveness may vary by procedure type and sedation status, underscoring the importance of tailoring interventions to clinical context. Future research should prioritize direct intervention trials with standardized methodologies to enhance the robustness of findings and establish causal relationships.