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McKechnie T, Heimann L, Kazi T, Jessani G, Lee Y, Sne N, Hong D, Eskicioglu C. Starting position during colonoscopy: a systematic review and meta-analysis of randomized controlled trials. Tech Coloproctol 2024; 28:39. [PMID: 38507105 DOI: 10.1007/s10151-024-02912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Traditional teaching has been to place patients in the left lateral decubitus starting position for colonoscopies. Recent randomized controlled trials (RCTs) have compared left lateral decubitus starting position to other approaches. The aim of this systematic review and meta-analysis was to compare different starting positions for colonoscopies and their effect on cecal intubation. METHODS MEDLINE, Embase, and CENTRAL were searched from inception to July 2023. Articles were eligible for inclusion if they were RCTs comparing at least two different starting positions for adults undergoing colonoscopy. The main outcome was cecal intubation time. Meta-analysis used an inverse variance random effects model. Risk of bias was assessed with the Cochrane Tool for RCTs 2.0. RESULTS After screening 1523 citations, 14 RCTs were included. Four studies compared left lateral decubitus to right lateral decubitus, four studies compared left lateral decubitus to left lateral tilt-down, three studies compared left lateral decubitus to prone, and three studies compared left lateral decubitus to supine. There were no statistically significant differences in cecal intubation time in seconds across all comparisons: left lateral decubitus vs. right lateral decubitus (MD 14.9, 95% CI - 111.8 to 141.6, p = 0.82, I2 = 85%); left lateral decubitus vs. left lateral tilt-down (MD - 31.3, 95% CI - 70.8 to 8.3, p = 0.12, I2 = 82%); left lateral decubitus vs. prone (MD 17.2, 95% CI - 174.9 to 209.4, p = 0.86, I2 = 94%); left lateral decubitus vs. supine (MD - 149.9, 95% CI - 443.6 to 143.9, p = 0.32, I2 = 89%). CONCLUSION The starting position for colonoscopies likely does not influence cecal intubation time. This study was limited by heterogeneity.
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Affiliation(s)
- T McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - L Heimann
- Liberty University, Lynchburg, VA, USA
| | - T Kazi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - G Jessani
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Y Lee
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - N Sne
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - D Hong
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - C Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
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Li J, Zhang D, Wei Y, Chen K, Wu R, Peng K, Hou X, Li L, Huang C, Wang Y, Xun L, Xu H, Wang J, Chen Z, Shen M, Liu F. Colorectal Sessile Serrated Lesion Detection Using Linked Color Imaging: A Multicenter, Parallel Randomized Controlled Trial. Clin Gastroenterol Hepatol 2023; 21:328-336.e2. [PMID: 35390509 DOI: 10.1016/j.cgh.2022.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Linked color imaging (LCI) is a novel technology that improves the color differences between colorectal lesions and the surrounding mucosa. The present study aims to compare the detection of colorectal sessile serrated lesions (SSL) using LCI with white light imaging (WLI). METHOD A large-scale, multicenter, parallel prospective randomized controlled trial was conducted in 4 hospitals in China. The participants were randomly assigned to the LCI group and WLI group. The primary endpoint was the SSL detection rate (SDR). RESULTS A total of 884 patients were involved in the intention-to-treat analysis, with 441 patients in the LCI group and 443 patients in the WLI group. The total polyp detection rate, adenoma detection rate, and SDR were 51.8%, 35.7%, and 8.6%, respectively. The SDR was significantly higher in the LCI group than in the WLI group (11.3% vs 5.9%, P = .004). Furthermore, LCI significantly increased the number of polyps and adenomas detected per patient, when compared with WLI (P < .05). In addition, there was higher detection rate of diminutive and flat lesions in the LCI group (P < .05). Multivariate analysis revealed that LCI is an independent factor associated with SDR (hazard ratio, 1.990; 95% confidence interval, 1.203-3.293; P = .007), along with withdrawal time (hazard ratio, 1.157; 95% confidence interval, 1.060-1.263; P = .001) and operator experience (hazard ratio, 1.850; 95% confidence interval, 1.045-3.273; P = .035). CONCLUSIONS LCI is significantly superior to WLI for SSL detection, and may improve polyp and adenoma detection. LCI can be recommended as an appropriate method for routine inspection during colonoscopy (http://www.chictr.org.cn number, ChiCTR2000035705).
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Affiliation(s)
- Jun Li
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Di Zhang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunlei Wei
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kan Chen
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ruijin Wu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kangsheng Peng
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaojia Hou
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Li
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chao Huang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuxin Wang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Linjuan Xun
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongwei Xu
- Department of Gastroenterology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Yangzhou University, Kunshan, China
| | - Jianhua Wang
- Department of Gastroenterology, The First People's Hospital of Kunshan, Kunshan, China
| | - Zhirong Chen
- Department of Gastroenterology, Suzhou Municipal Hospital (Eastern), Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, China
| | - Ming Shen
- Department of Gastroenterology, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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Bao Z, Hu C, Zhu L, Wang W. Study on the effectiveness of modified colonoscopy nursing pads in colonoscopy. BMC Gastroenterol 2022; 22:531. [PMID: 36539692 PMCID: PMC9768946 DOI: 10.1186/s12876-022-02493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/31/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the effect of modified colonoscopy nursing pads in colonoscopy. METHODS A total of 262 subjects who underwent colonoscopy at our endoscopy center between September 1, 2021 and February 28, 2022 were selected and randomly divided into a control group and an experimental group, with 131 cases in each group. The control group used conventional nursing pads, while the experimental group used modified nursing pads. The success rate of the first correct position, the time spent by the nurse to guide the correct position, the bed unit contamination rate, the contamination rate of the operator's protective equipment, the privacy protection of the examinees and the satisfaction degree after the examination were compared between the two groups. RESULTS The success rate of the first correct position of the examinees in the experimental group was significantly higher than that of the control group (P < 0.05), and the time spent by the nurses to guide the correct position in the experimental group was less than that of the control group (P < 0.05). The bed unit contamination rate and operator's protective equipment contamination rate of the experimental group were lower than those of the control group, and the satisfaction degree of the examinees was higher in the experimental group than in the control group, and the differences were statistically significant (P < 0.05). CONCLUSION The modified colonoscopy nursing pad can save the time of correct colonoscopy positioning of examinees, improve the efficiency of colonoscopy, reduce the workload of nursing staff, effectively protect the privacy of patients, reduce the bed unit contamination and protective equipment contamination, and then improve the comfort and satisfaction of patients.
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Affiliation(s)
- Zhenfei Bao
- grid.416271.70000 0004 0639 0580Department of Endoscopy Center, Ningbo First Hospital, No.59 of Liuting Street, Haishu District, Zhejiang, 315010 China
| | - Chunyan Hu
- grid.416271.70000 0004 0639 0580Department of Endoscopy Center, Ningbo First Hospital, No.59 of Liuting Street, Haishu District, Zhejiang, 315010 China
| | - Lei Zhu
- grid.416271.70000 0004 0639 0580Department of Endoscopy Center, Ningbo First Hospital, No.59 of Liuting Street, Haishu District, Zhejiang, 315010 China
| | - Weihong Wang
- grid.416271.70000 0004 0639 0580Department of Endoscopy Center, Ningbo First Hospital, No.59 of Liuting Street, Haishu District, Zhejiang, 315010 China
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Kim JH, Choi YJ, Kwon HJ, Oh GM, Jung K, Kim SE, Moon W, Park MI, Park SJ. Colonoscopy Insertion in Patients with Gastrectomy: Does Position Impact Cecal Intubation Time? Dig Dis Sci 2022; 67:4533-4540. [PMID: 35122594 DOI: 10.1007/s10620-021-07325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/03/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND A history of abdominal surgery is associated with difficulty in colonoscopy insertion. Few studies have reported effective colonoscopy insertion for patients who underwent abdominal surgery due to stomach cancer. AIM We aimed to compare the impact of supine position (SP) and left lateral position (LLP) as the starting position of colonoscopy insertion in patients who underwent abdominal surgery due to stomach cancer. METHODS This was a prospective, randomized controlled trial. Patients undergoing colonoscopy for screening or post-polypectomy surveillance after gastrectomy due to stomach cancer were enrolled and randomized to the SP or LLP group as the starting position of colonoscopy insertion. All colonoscopic examinations were performed with a transparent cap. The primary outcome was to compare the cecal intubation time between the two groups. RESULTS A total of 224 patients were enrolled. The mean cecal intubation time was not significantly different between the SP and LLP groups (364.5 s versus 306.9 s; p = 0.105). In patients with a lower body mass index (< 21 kg/m2) or who underwent gastrectomy within three years, the mean cecal intubation time of the LLP group was shorter than the SP group. In the multivariate analysis for the factors affecting to increase in the cecal intubation time (> 5 min), the starting position was not an independent factor. CONCLUSION Either the SP or LLP could serve as a possible starting position of colonoscopy insertion for patients who underwent abdominal surgery due to stomach cancer.
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Affiliation(s)
- Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Youn Jung Choi
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Hye Jung Kwon
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Gyu Man Oh
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea.
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Ramai D, Singh J, Brooks OW, Barakat M, Mohan BP, Chandan S, Khan SR, Dhindsa B, Dhaliwal A, Ofosu A, Adler DG. Comparison of left versus right lateral starting position on colonoscopy: a systematic review and meta-analysis of randomized controlled trials. Ann Gastroenterol 2021; 34:699-704. [PMID: 34475741 PMCID: PMC8375655 DOI: 10.20524/aog.2021.0639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background Modifying patient position during colonoscopy has been proposed as a simple and inexpensive technique to increase luminal distention and improve navigation through the large bowel. The left lateral (LL) decubitus starting position is commonly used during colonoscopy. However, reports indicate that other starting positions may offer additional benefit. We aimed to determine if the right lateral (RL) starting position compared to the standard LL starting position could improve outcomes in colonoscopy. Methods We searched PubMed, Medline, and EMBASE through June 2020 to identify studies comparing RL and LL starting positions during colonoscopy. The primary outcomes included mean cecal insertion time and cecal intubation rate, and adverse events were assessed by pooling data using a random-effects model expressed in terms of odds ratio (OR), mean difference, and 95% confidence interval (CI). Results We identified 5 randomized controlled trials, including 809 participants, that compared LL vs. RL colonoscopy. The pooled OR for cecal intubation rate was 1.3 (95%CI 0.8-2.3; P=0.3). The mean difference in mean cecal insertion time was 0.08 (95%CI -0.09 to 0.26; P=0.4). Heterogeneity between studies was low (I 2=0%). No complications were reported in either arm of the study. Pain scores assessed using a visual analog scale were comparable among both arms of the study. Conclusion The RL starting position for colonoscopy was comparable to the LL and offered no additional benefit in terms of cecal intubation time, intubation rate, or patient discomfort.
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Affiliation(s)
- Daryl Ramai
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York (Daryl Ramai, Olivia W. Brooks)
| | - Jameel Singh
- Department of Internal Medicine, Mather Hospital, Port Jefferson, New York (Jameel Singh)
| | - Olivia W Brooks
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York (Daryl Ramai, Olivia W. Brooks)
| | - Mohamed Barakat
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York (Mohamed Barakat)
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah (Babu P. Mohan, Douglas G. Adler)
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, Nebraska (Saurabh Chandan)
| | - Shahab R Khan
- Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois (Shahab R. Khan)
| | - Banreet Dhindsa
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Banreet Dhindsa)
| | - Amaninder Dhaliwal
- Division of Gastroenterology, Moffitt Cancer Center, University of South Florida, Tampa, Florida (Amaninder Dhaliwal)
| | - Andrew Ofosu
- Division of Gastroenterology, Stanford University, Stanford, California (Andrew Ofosu), USA
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah (Babu P. Mohan, Douglas G. Adler)
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Wang RG. Progress and prospects of artificial intelligence in colonoscopy. Artif Intell Gastrointest Endosc 2021; 2:63-70. [DOI: 10.37126/aige.v2.i3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/29/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is a branch of computer science. As a new technological science, it mainly develops and expands human intelligence through the research of intelligence theory, methods and technology. In the medical field, AI has bright application prospects (for example: imaging, diagnosis and treatment). The exploration of robotic gastroscopy and colonoscopy systems is not only a bold attempt, but also an inevitable trend of AI in the development of digestive endoscopy in the future. Based on the current research findings, this article summarizes the research progress of colonoscopy, and looking forward for the application of AI in colonoscopy.
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Affiliation(s)
- Rui-Gang Wang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
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Lin SY, Yaow CYL, Ng CH, Wong NW, Tham HY, Chong CS. Different position from traditional left lateral for colonoscopy? A meta-analysis and systematic review of randomized control trials. Chronic Dis Transl Med 2021; 7:27-34. [PMID: 34013177 PMCID: PMC8110879 DOI: 10.1016/j.cdtm.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Colonoscopy requires the intubation of the cecum for screening of colorectal diseases. The conventional position used for colonoscopy is the left lateral position (LLP). However, alternative positions have also been utilized to enhance the success of intubation. Thus, the aim of this study was to perform a meta-analysis of the different positions to determine the effectiveness of the individual positions for successful colonoscopy. METHODS Medline, Embase and Cochrane trials electronic databases were searched for studies on colonoscopy positions. The primary outcome was defined as the cecal intubation rate. Pooled risk ratios (RR) and 95% confidence intervals (CI) for the rates of cecal intubation were estimated. Secondary outcomes such as the cecal intubation time and adenoma detection rate were further analyzed qualitatively. RESULTS After reviewing 644 identified records, 7 randomized control trials (RCT) studies were included. No significant difference was observed in either comparisons, between the LLP vs. supine position (SP) (RR = 1.01, 95% CI, 0.98 to 1.04, P = 0.55) or the LLP vs. prone position (PP) (RR = 1.02, 95% CI, 0.98 to 1.06, P = 0.27). CONCLUSIONS Amidst available literature, the use of other positions can be considered when performing colonoscopy. These further highlights that the existential practice is based predominantly on familiarity instead of evidence-based-research.
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Affiliation(s)
- Snow Yunni Lin
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Clyve Yu Leon Yaow
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Cheng Han Ng
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Neng Wei Wong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Hui Yu Tham
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Choon Seng Chong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
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Watanabe J, Park D, Kakehi E, Inoue K, Ishikawa S, Kataoka Y. Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis. Endosc Int Open 2020; 8:E848-E860. [PMID: 32617389 PMCID: PMC7297618 DOI: 10.1055/a-1149-1541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims We aimed to assess the efficacy and safety of the starting position during colonoscopy. Patients and methods We searched CENTRAL, MEDLINE, EMBASE, and the WHO International Clinical Trials Registry Platform through February 2019 to identify studies reporting the comparison between the right/supine/prone/tilt-down and left lateral starting position during colonoscopy. The primary outcomes were mean cecal insertion time and adverse events requiring medication. Two reviewers performed study selection and risk of bias assessment. We determined the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation method. This study was registered in PROSPERO (CRD42019124360). Results We identified 10 randomized controlled trials (RCTs) (2083 participants), including three trials on right/tilt-down versus left, two trials on supine/prone versus left, respectively. Mean difference in mean cecal insertion time in supine versus left was -41.0 s (95 % confidence interval [CI] -57.3 to -24.7) in one study and in tilt-down versus left was - 37.3 s (95 % CI -72.1 to -2.4; I 2 = 58 %) in three studies; however, there were no statistically significant differences in prone/right versus left position (very low certainty of evidence). Four of eight studies noted adverse effects requiring medication (moderate certainty of evidence). One RCT applying the tilt-down position was terminated because of increased occurrence of oxygen desaturation. Conclusion We could not conclusively determine the efficacy and safety of the starting position during colonoscopy because of low certainty of evidence. Further studies are needed to confirm the efficacy and safety of the starting potion during colonoscopy.
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Affiliation(s)
- Jun Watanabe
- Center for Community Medicine, Jichi Medical University, Yakushiji Shimotsuke, Japan,Department of Surgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Daeho Park
- Department of Community-based Family Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori, Japan,Daisen Clinic, 475 Imazaike, Daisen Town, Tottori, Japan
| | - Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Kazuoki Inoue
- Department of Community-based Family Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Shizukiyo Ishikawa
- Center for Community Medicine, Jichi Medical University, Yakushiji Shimotsuke, Japan
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
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Impact of the supine position versus left horizontal position on colonoscopy insertion: a 2-center, randomized controlled trial. Gastrointest Endosc 2019; 89:1193-1201.e1. [PMID: 30660634 DOI: 10.1016/j.gie.2019.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colonoscopy insertion is painful for some patients and is one of the main barriers to screening colonoscopy. Few studies have assessed the impact of the supine position (SP) on colonoscopy insertion, especially for unsedated patients. The aim of this randomized controlled trial was to clarify this issue. METHODS Unsedated patients were randomized to SP or left horizontal position (LHP) as the starting position of colonoscopy insertion. The primary outcome measure was cecal intubation time (CIT), and the secondary outcome measures were descending colon intubation time (DIT), pain score of patients, difficulty score according to the endoscopist, and patients' acceptance of unsedated colonoscopy. RESULTS A total of 347 patients were randomized to the SP group (175) or the LHP group (172). The CIT in the SP group was significantly shorter than that in the LHP group (275.0 seconds [interquartile range (IQR), 234.0-328.5 seconds] versus 316.0 seconds [IQR, 261.0-370.0 seconds], P < .001). The DIT was also shorter in the SP group (64.5 seconds [IQR, 52.0-86.3 seconds] versus 74.0 seconds [IQR, 62.0-92.0 seconds], P = .001). Compared with the LHP, the SP had a lower pain score (3.3 versus 3.9, P = .002), a lower difficulty score (3.1 versus 3.7, P < .001), a lower frequency of position change (7.1% versus 38.0%, P < .001), and less need for abdominal compression (39.1% versus 45.5%, P = .02). SP was the only modifiable and independent factor identified to reduce CIT and pain score and improve patients' acceptance of unsedated colonoscopy. CONCLUSIONS As an economical and convenient method, SP can reduce CIT, ease pain, and improve patients' acceptance of unsedated colonoscopy. (Clinical trial registration number: NCT03289442.).
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