Introduction Many endoscopists withdraw the colonoscope with the patient in a single position (left lateral or supine), while others advocate position change. A previous study in a small group of patients suggested position change is beneficial in the transverse and left colon. We have compared colonoscope withdrawal in the supine position with position change.
Methods A randomised cross-over study compared colonoscope withdrawal in the supine position with position change (caecum to hepatic flexure in the left lateral position, transverse colon in the supine position and the hepatic flexure and descending colon in the right lateral position). Colonic segments were precisely defined using biopsy sites as markers, aided by a Scopeguide imager. Segments were cleansed and examined for at least 2 minutes during which air was insufflated to distend the colon. After each segment was examined the colonoscope was reinserted and the same segment was re-examined in the alternative position. Luminal distension was rated on a validated 5 point scale, ranging from 1 = completely collapsed to 5 = maximal distension. Ordinal and categorical data were compared with the Mann Whitney U test and Fisher’s exact test respectively.
Results This is an interim analysis of 65 patients (mean age 62, 38 male). 30 patients were initially examined in the supine position and 35 patients with position change. Distension scores were higher in the right colon when examined in the left lateral position (mean = 3.9 vs. 3.5 p = < 0.001), and in the left colon when examined in the right lateral position (4.4 vs. 3.6, p = < 0.001) (see table 1). The proportion of patients with scores of 4–5 (adequate) were higher in the right colon when examined in the left lateral position (42/65 vs. 27/65, p = 0.014) and in the left colon when examined in the right lateral position (59/65 vs. 34/65, p = < 0.001). There was no significant carry-over effect in any of the examined segments.
Conclusion Position change improves suboptimal distension of the right and left colon. Further analysis of this study will clarify whether position change also improves polyp detection.
Disclosure of Interest None Declared
East JE et al. Position changes improve visibility during colonoscope withdrawal: a randomised, blinded, crossover trial. Gastrointest Endosc. Feb 2007; 65(2):263–269.
East JE et al. Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomised, crossover trial. Gastrointest Endosc. Mar 2011; 73(3):456–463.