A randomized controlled trial assessing the effect of prescribed patient position changes during colonoscope withdrawal on adenoma detection

Expert opinions and scientific evidence for colonoscopy key performance indicators

“…Position change : Changing patient position seems to slightly increase ADR,114 especially if colonoscopy is difficult115 116; however again, results vary, with one recent randomised trial suggesting no improvement,117 one suggesting an improvement in ADR distal to the hepatic flexure118 and another suggesting that examining the right side of the colon in the left lateral position significantly improved ADR in the right colon 119…”

Quantitative assessment of the effect of position changes during colonoscopy withdrawal

“…Its use during colonoscopy withdrawal originates from the experiences with barium enemas and computed tomography (CT) colonography, where position change can promote the adequate distension of the colon and the movement of excess fluid away from the area being observed . Although position change during colonoscopy withdrawal has been recommended by some experts as it may increase the ADR, especially in the right lateral position at splenic flexure, routine position change during colonoscopy withdrawal are not widely advocated due to the conflicting results of clinical trials . An increase in the withdrawal time, the difficulty of moving deeply sedated patients, a lack of awareness of its potential advantages and the paucity of strong evidence supporting its efficacy could be the reasons why endoscopists are reluctant to change the patients' position during colonoscopy withdrawal.…”

“…Recently, two randomized trials also showed that changing the patient's position could improve the ADR . However, two randomized parallel‐group studies did not confirm this finding after dynamic position changes . Therefore, it is not clear whether position change during colonoscopy withdrawal can improve the quality of colonoscopic examination.…”

Position change during colonoscopy: the oldest and best trick in the book

“…Another perceived problem with position changes is that they may slow the colonoscopy process. However, in a study from Ou et al, 5 it took, on average, just an additional 44 seconds to complete position changes per examination. Although not studied to date, subsequent polypectomy after optimizing patient position is likely to be a much quicker process, more than compensating for the added time to perform the move as well as enhancing control and safety.…”