OC-053 Results of the rolcol study: a randomised controlled trial of right versus left starting position in colonoscopy

McGrath, Adrian; Stoddart, C H; Vergis, Nikhil; Hoare, JM

doi:10.1136/gutjnl-2015-309861.53

Cited by 2 publications

(4 citation statements)

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“…This suggests that if a recessively-acting, high-risk factor is responsible for BA in this iwi, it is attributable to relatedness to common remote ancestors that is not discernible from the high rate of homozygosity in the Māori population more generally, at least using the genomic tools deployed here. This level of homozygosity is not unusual in populations with a recent history of founder effects, such as seen in present-day Finland [79, 80], Iceland [82] and the Greater Middle East [83]. For instance, similar levels of HBS have been seen in Finnish populations originating from founder groups 300–400 years ago [81], in which 90% of samples had runs of HBS > 5 cM.…”

Section: Discussionmentioning

confidence: 54%

“…Regional geographical clusters of BA have not been reported before, apart from a high rate reported in French Polynesia [14, 35] and a slight increase in one Scottish region [80], although the NZ iwi risk is an order of magnitude greater than the incidence in these areas. Of particular note is that all of the affected iwi children were born in the last quarter-century, suggesting a recently encountered environmental factor could have precipitated the development of BA in the presence of a genetic predisposition.…”

Section: Discussionmentioning

confidence: 93%

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Genetic investigation into an increased susceptibility to biliary atresia in an extended New Zealand Māori family

et al. 2018

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BackgroundBiliary atresia (BA), a fibrosing disorder of the developing biliary tract leading to liver failure in infancy, has an elevated incidence in indigenous New Zealand (NZ) Māori. We investigated a high rate of BA in a group of children (n = 12) belonging to a single Māori iwi (or ‘tribe’, related through a remote ancestor).MethodsPopulation and geographical data was used to estimate the rate of BA in Māori sub-groups, and a pedigree linking most of the affected children was constructed from oral and documented history. Array genotyping was used to examine hypotheses about the inheritance of a possible genetic risk factor, and the history of the affected population, and Exome Sequencing to search for candidate genes.ResultsMost of these affected children (n = 7) link to a self-reported pedigree and carry a 50-fold increase in BA risk over unrelated Māori (χ2 = 296P < 0.001, 95% CI 23–111). Genetic analysis using FEstim and SNP array genotypes revealed no evidence for elevated consanguinity between parents of affected children (FEstim: F (2,21) = 0.469, P > 0.63). Genome-wide quantitation of intervals of contiguous, homozygous-by-state markers reached a similar conclusion (F (2,399) = 1.99, P = 0.138). Principal component analysis and investigation with STRUCTURE found no evidence of increased allele frequency of either a recessive variant, or additive, low-risk variants due to reproductive isolation. To identify candidate causal factors, Exome Sequencing datasets were scrutinised for shared rare coding variants across 8 affected individuals. No rare, non-synonymous, phylogenetically conserved variants were common to 6 or more affected children.ConclusionThe substantially elevated risk for development of BA in this subgroup could be mediated by genetic factors, but the iwi exhibits no properties indicative of recent or remote reproductive isolation. Resolution of any risk loci may rely on extensive genomic sequencing studies in this iwi or investigation of other mechnaisms such as copy number variation.Electronic supplementary materialThe online version of this article (10.1186/s12920-018-0440-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 93%

Genetic investigation into an increased susceptibility to biliary atresia in an extended New Zealand Māori family

et al. 2018

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“…Several studies noted the effects of the endoscopist's perception of the difficulty of colonoscopy when the position was PP, 28 RLP 36 and SP 25 was utilised. While one study showed that colonoscopies conducted in the PP position may be more challenging due to increased difficulty in negotiating the left colon, 28 others indicated that colonoscopies in the SP and RLP were easier and the extent of difficulty discrepancies were based on endoscopist experience, 25 , 36 with those who are more experienced feeling less of a difference. 36 Given this fact, trainees should be exposed to various colonoscopy starting positions and made aware of their choices on a case-by-case basis.…”

Section: Discussionmentioning

confidence: 99%

“…While one study showed that colonoscopies conducted in the PP position may be more challenging due to increased difficulty in negotiating the left colon, 28 others indicated that colonoscopies in the SP and RLP were easier and the extent of difficulty discrepancies were based on endoscopist experience, 25 , 36 with those who are more experienced feeling less of a difference. 36 Given this fact, trainees should be exposed to various colonoscopy starting positions and made aware of their choices on a case-by-case basis. For example, in obese patients, starting colonoscopy in the PP has been reported to result in shorter cecal intubation times and decreased need for patient repositioning.…”

Section: Discussionmentioning

confidence: 99%

Different position from traditional left lateral for colonoscopy? A meta‐analysis and systematic review of randomized control trials

Lin

Yaow

et al. 2021

Chronic Diseases and Translational Medicine

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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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OC-053 Results of the rolcol study: a randomised controlled trial of right versus left starting position in colonoscopy

Cited by 2 publications

References 0 publications

Genetic investigation into an increased susceptibility to biliary atresia in an extended New Zealand Māori family

Genetic investigation into an increased susceptibility to biliary atresia in an extended New Zealand Māori family

Different position from traditional left lateral for colonoscopy? A meta‐analysis and systematic review of randomized control trials

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