Original ArticleClinical EndoscopyPosition changes improve visibility during colonoscope withdrawal: a randomized, blinded, crossover trial
Section snippets
Patients and methods
Patients who present for routine colonoscopy who fulfilled the inclusion criteria were invited to participate. All patients gave written informed consent, and the protocol was approved by the local research ethics committee. The inclusion criterion was all patients aged 50 to 80 years who presented for routine colonoscopy. Exclusions included those with previous bowel resection; known colitis; known familial adenomatous polyposis; those with severe musculoskeletal problems; or those unable or
Results
Sixteen patients were recruited. Two patients had technically difficult colonoscopies and so were not randomized. Results are presented for the remaining 14 patients who were randomized and completed both sequences.
The mean patient age was 60 years, range, 51 to 79 years. There were 4 men and 10 women. Indications for colonoscopy were as follows: polyp follow-up, 6; family history of colorectal cancer, 6; anemia, 1; and change in bowel habit, 1. Colonoscopy was complete to the cecum in all
Discussion
Adequate luminal distension is vital for an effective diagnosis of neoplasia at colonoscopy. This study demonstrated that changing the patient's position during colonoscopy when viewing the transverse colon, the splenic flexure, and the descending colon significantly improved luminal distension when the withdrawal time is fixed. Colonoscopists should be encouraged by these data to adopt these maneuvers as part of their routine colonoscopic practice during withdrawal. The mean differences seen
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See CME section; p. 282.
The data from this paper have been presented at the British Society of Gastroenterology Meeting, March 20-23, 2006, Birmingham, UK (oral presentation), and at Digestive Disease Week, May 21-24, 2006, Los Angeles, Calif (Gastrointest Endosc 2006;63:AB207).