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

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).

• Authors: James E East, Paul Bassett, Naila Arebi, Siwan Thomas-Gibson, Thomas Guenther, Brian P Saunders
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 73 Issue 3 Pg. 456-63 (Mar 2011) ISSN: 1097-6779 [Electronic] United States
• PMID: 20950801 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Topics

• Adenoma (diagnosis)
• Adult
• Aged
• Aged, 80 and over
• Cecum (pathology)
• Colon (pathology)
• Colonic Neoplasms (diagnosis)
• Colonic Polyps (diagnosis)
• Colonoscopy (methods)
• Cross-Over Studies
• Early Detection of Cancer (methods)
• Female
• Humans
• Male
• Middle Aged
• Patient Positioning
• Supine Position