Effect of patient position change during the colonoscopy withdrawal phase on increasing adenoma detection rate: a randomized controlled trial

Abstract

Background: Improvement in adenoma detection rate (ADR) reduces colorectal cancer incidence by increasing the colonoscopy quality. Using dynamic patient position changes during the withdrawal phase has shown promise in increasing ADR. We conducted this study to assess the effectiveness of the supine position on the improvement of ADR to improve its feasibility and avoid frequent patient position changes, particularly in sedated patients.Methods: This was a randomized, single-blind, parallel-group, single-center study implemented in the Mehregan private in Babol. Inclusion criteria were 40 to 85 years old, 4 L application of polyethylene glycol from the day before the procedure, no history of inflammatory bowel disease, bowel surgery, musculoskeletal problems, and negative familial history of colorectal cancer. Patients were allocated in a 1:1 ratio to the supine or left lateral positions during the withdrawal phase. All colonoscopies were performed by a single physician using a Fujifilm colonoscope. A P-value of <0.005 was considered statistically significant.Results: A total of 880 patients were assessed for eligibility, of which 472 patients were included in the final analysis; 53.4% were female, the mean age of participants was 55.86±10.30 years old, 95.1% of patients had adequate bowel preparation, and adenomatous polyps were the most common histopathologic type (63.7%). Despite the intervention group’s higher rate of ADR and PDR (19.5% vs. 17.7% for ADR and 27.2% vs. 26.5% for PDR), no statistically significant difference in ADR or PDR was detected (P=0.613 and 0.866). Conclusion: No statistical significance was observed despite the increase in ADR when the supine position was used exclusively during the withdrawal phase. As a result, we recommend that the dynamic position change method be used if a position change is required. Nonetheless, additional research is required to determine a more effective alternative to dynamic position change in obese or heavily sedated patients.Trial registration: IRCTID: IRCT20110721007080N5, registration date: 04/05/2020