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Position changes improve visibility during colonoscope withdrawal: a randomized, blinded, crossover trial.

James E East¹, Noriko Suzuki, Naila Arebi

¹Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, Middlesex, UK.

Gastrointestinal Endoscopy

|December 5, 2006

Summary

Routine position changes during colonoscopy significantly improve luminal distension, aiding neoplasia detection. This simple intervention enhances visualization and may reduce missed adenomas and early cancers.

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Area of Science:

Gastroenterology
Endoscopy
Medical Imaging

Background:

Adequate colonic distension is crucial for detecting neoplasia during colonoscopy withdrawal.
Position changes can enhance distension but are not consistently used in practice.

Purpose of the Study:

To evaluate if routine patient position changes improve luminal distension during colonoscope withdrawal.
To assess the impact of position changes on the diagnostic quality of colonoscopy.

Main Methods:

A randomized, blinded, crossover trial was conducted with 14 patients at a UK tertiary-referral center.
Colonoscopies involved back-to-back examinations with and without position changes (left lateral, supine, right lateral).
Luminal distension was scored by a blinded reviewer on a 1-5 scale; a score of ≤2 was considered inadequate.

Main Results:

Luminal distension scores were significantly higher with position changes in the transverse, splenic flexure, and descending colon (P = .02, .002, <.001).
Without position changes, 43% of patients had inadequate distension in at least one colonic area (P = .03).

Conclusions:

Routine position changes during colonoscope withdrawal improve luminal distension.
This cost-neutral intervention can enhance visualization and potentially reduce miss rates for adenomas and early cancers.