Elsevier

Gastrointestinal Endoscopy

Volume 65, Issue 2, February 2007, Pages 263-269
Gastrointestinal Endoscopy

Original Article
Clinical Endoscopy
Position changes improve visibility during colonoscope withdrawal: a randomized, blinded, crossover trial

https://doi.org/10.1016/j.gie.2006.04.039Get rights and content

Background

Adequate distension is essential to maximize neoplasia detection during colonoscope withdrawal. Position changes may improve distension but are often not performed in routine practice.

Objective

To assess whether routine position changes improve luminal distension during colonoscope withdrawal.

Design

Randomized, blinded, crossover trial.

Setting

Single tertiary-referral center, United Kingdom.

Patients

Fourteen patients attending for routine colonoscopy.

Interventions

Videotaped, back-to-back examination of colon proximal to rectosigmoid junction in left lateral position only, then with position changes: left lateral for the cecum to the hepatic flexure, supine for the transverse colon, and right lateral for the splenic flexure and the descending colon, or vice versa.

Main Outcome Measurements

Luminal distension as scored by a blinded video reviewer. Luminal distension was scored on a scale of 1 to 5 for each colonic area: 1, complete collapse; 5, widely distended to limit of view. A score of 2 or less was considered inadequate for diagnosis.

Results

Scores for the 2 examinations from the blinded video reviewer were significantly higher in the transverse, the splenic flexure, and the descending colon, P = .02, .002, and <.001, respectively. Without position changes, 6 of 14 of patients (43%) would have had a nondiagnostic distension score (1 or 2) in at least 1 colonic area, P = .03.

Limitations

Nonvalidated scoring system for luminal distension, however, good agreement between endoscopist and blinded reviewer, weighted kappa 0.53, 95% confidence interval 0.38-0.69.

Conclusions

Position change, a cost-neutral intervention, during colonoscope withdrawal improved luminal distension between hepatic flexure and sigmoid-descending junction and has the potential to reduce adenoma and early cancer miss rates.

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

Cited by (82)

  • Upskilling Pediatric Ileocolonoscopy

    2023, Gastrointestinal Endoscopy Clinics of North America
  • Colonoscopy core curriculum

    2021, Gastrointestinal Endoscopy
    Citation Excerpt :

    Repositioning the patient from the left lateral decubitus position to the supine or right lateral position may be useful when encountering difficulty with navigation, tight corners, or when looping occurs. Additionally, systematic position change during withdrawal has been shown to be a simple and cost-neutral intervention to improve adenoma detection rate that does not significantly increase procedure time.31-37 Position change facilitates adequate distension at different colonic segments as gas rises to the least dependent areas and fluid moves to the more dependent areas.

  • Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial

    2017, Gastrointestinal Endoscopy
    Citation Excerpt :

    WLI was used for colonoscope insertion up to the cecum in both groups. Patients in both groups were placed in the same position during the examination because changing the position influenced the detection rate.28 An examiner assessed the quality of bowel preparation according to the extent of mucosal visualization after suctioning the fluid residue, following the Aronchick Bowel Preparation Scale: excellent (≥95% mucosal visualization), good (90%-95% mucosal visualization), fair (80%-90% mucosal visualization), and poor (<80% mucosal visualization).29

View all citing articles on Scopus

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).

View full text