Colonoscopy Insertion in Patients with Gastrectomy: Does Position Impact Cecal Intubation Time?

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Devices

Background:

• Abdominal surgery history, particularly for stomach cancer, complicates colonoscopy insertion.
• Limited research exists on effective colonoscopy techniques for post-gastrectomy patients.

Purpose of the Study:

• To compare the efficacy of supine position (SP) versus left lateral position (LLP) as initial insertion postures for colonoscopy in stomach cancer surgery patients.
• To evaluate the impact of starting position on cecal intubation time.

Main Methods:

• Prospective, randomized controlled trial involving 224 patients undergoing colonoscopy post-gastrectomy.
• Patients were randomized to start colonoscopy in either SP or LLP, using a transparent cap.
• Primary outcome measured was the time to cecal intubation.

Main Results:

• No significant difference in mean cecal intubation time between SP and LLP groups (p=0.105).
• LLP demonstrated shorter cecal intubation times in patients with BMI < 21 kg/m² or within 3 years post-gastrectomy.
• Starting position was not an independent factor for prolonged cecal intubation (>5 min).

Conclusions:

• Both SP and LLP are feasible starting positions for colonoscopy in patients with a history of stomach cancer surgery.
• The choice of starting position may be optimized based on individual patient factors like BMI and time since surgery.