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Gastrointest Endosc. 2011 Mar;73(3):456-63. doi: 10.1016/j.gie.2010.07.046. Epub 2010 Oct 15.

Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial.

Author information

1
Wolfson Unit for Endoscopy, St. Mark’s Hospital, Imperial College London, London. jameseast6@yahoo.com

Abstract

BACKGROUND:

Colonoscopy has a miss rate for adenomas that may partly relate to poor visualization of the colonic surface. Dynamic position changes during colonoscope withdrawal can improve luminal distension.

OBJECTIVE:

To assess whether position changes also improve adenoma and polyp detection.

DESIGN:

Randomized crossover clinical trial.

SETTING:

Academic endoscopy unit.

PATIENTS:

This study involved 130 patients who presented for routine colonoscopy.

INTERVENTION:

Examination either entirely in the left lateral position followed by position changes (cecum to hepatic flexure, left lateral; transverse colon, supine; splenic flexure and descending colon, right lateral) or vice versa. After both examinations, polyps were removed for histopathology.

MAIN OUTCOME MEASUREMENTS:

Proportion of patients with ≥1 polyp or adenoma detected between the hepatic flexure and the sigmoid-descending colon junction. Luminal distension was measured on a scale of 1 to 5: 1, total collapse; 5, fully distended.

RESULTS:

At least 1 adenoma was detected in 34% of patients in colon areas in which the patient position differed from left lateral (transverse colon, splenic flexure, descending colon) compared with 23% examined with the patient in the left lateral position alone (P = .01). At least 1 polyp was detected in 52% of patients with position changes versus 34% of patients examined in the left lateral position alone (P < .001). Adenoma and polyp detection were positively correlated with an improved distension score (correlation coefficient, 0.12; P < .001). Adenomas were detected in 16% of colon areas with adequate distension scores (4 and 5) compared with 7% of those with borderline or nondiagnostic scores (1-3; P < .001).

LIMITATIONS:

Single-operator study.

CONCLUSION:

Dynamic position changes during colonoscope withdrawal significantly improved polyp and adenoma detection. (

CLINICAL TRIAL REGISTRATION NUMBER:

NCT00234650).

PMID:
20950801
DOI:
10.1016/j.gie.2010.07.046
[Indexed for MEDLINE]

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