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

Wilson, Ana; Saunders, Brian P.

doi:10.1016/j.gie.2015.03.1987

Cited by 14 publications

(4 citation statements)

References 6 publications

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“…A colonoscopy is considered the gold standard for colon cancer screening. Adenoma detection rate (ADR) has been established as a key performance indicator for the quality of colonoscopy [9]. Higher ADRs in screening colonoscopy were associated with lower lifetime risks of CRC and its mortality [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Colonoscopy Starting Position and Its Potential Outcomes

Shah¹,

Patel²,

Alsayed³

et al. 2022

Cureus

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Based on the literature review, many studies have been inconclusive in regards to adenoma detection and procedural positioning during a colonoscopy. Scope looping can make cecal intubation challenging, changing the positioning of the patient and application of external abdominal pressure can overcome this difficulty. A colonoscopy in a prone position can overcome these challenges and reduce cecal intubation time. It can thus improve the safety of the patient and the staff by minimizing the movement of a sedated patient.

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Section: Discussionmentioning

confidence: 99%

The Impact of the Colonoscopy Starting Position and Its Potential Outcomes

Shah¹,

Patel²,

Alsayed³

et al. 2022

Cureus

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“…These largely cost-neutral interventions may increase the diagnostic yield of colonoscopy through different mechanisms; although it is obvious that the presence of a second examiner-not necessarily a physician, an endoscopy nurse may serve this goal as well 20 -may help identify more lesions, changing the position of the patient during withdrawal facilitates adequate distention at different colonic segments without overdistention due to continuous air insufflation, and it maintains luminal gas rising to the least dependent parts and fluids to more dependent areas. 21 Water-immersion and water-exchange techniques comprise water-aided colonoscopy. Current RCT data suggest that these techniques facilitate cecal intubation, with water exchange being associated with an increase in ADR probably because of improvement of bowel preparation and the magnification effect of looking through water.…”

Section: Discussionmentioning

confidence: 99%

Compared Abilities of Endoscopic Techniques to Increase Colon Adenoma Detection Rates: A Network Meta-analysis

Facciorusso

Triantafyllou

Murad

et al. 2019

Clinical Gastroenterology and Hepatology

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e146. Learning Objective-Upon completion of this activity, successful learners will be able to list the endoscopic techniques that have been shown to increase colon adenoma detection rate; list the endoscopic techniques that have been shown to increase mean adenoma per patient compared with standard colonoscopy; and list the endoscopic techniques that have not been shown to improve colon adenoma detection rate. BACKGROUND AND AIMS:Adenoma detection rate (ADR) is a quality metric for colorectal cancer screening. We performed a systematic review and network meta-analysis to assess the overall and comparative efficacies of different endoscopic techniques in adenoma detection. METHODS:We performed a systematic review of published articles and abstracts, through March 15, 2018, to identify randomized controlled trials of adults undergoing colonoscopy that compared the efficacy of different devices in detection of adenomas. Our final analysis included 74 2-arm trials that comprised 44948 patients. These studies compared efficacies of add-on devices (cap, endocuff, endo-rings, G-EYE), enhanced imaging techniques (chromoendoscopy, narrow-band imaging, flexible spectral imaging color enhancement, blue laser imaging), new scopes (fullspectrum endoscopy, extra-wide-angle-view colonoscopy, dual focus), and low-cost optimizing existing resources (water-aided colonoscopy, second observer, dynamic position change), alone or in combination with high-definition colonoscopy or each other. Primary outcome was increase in ADR. We performed pairwise and network meta-analyses, and appraised quality of evidence using GRADE. RESULTS:Low-cost optimizing existing resources (odds ratio [OR], 1.29; 95% CI,1.17-1.43), enhanced imaging techniques (OR,1.21; 95% CI, 1.09-1.35), and add-on devices (OR,1.18; 95% CI, 1.07-1.29) were associated with a moderate increase in ADR compared with high-definition colonoscopy; there was low to moderate confidence in estimates. Use of newer scopes was not associated with significant increases in ADR compared with high-definition colonoscopy (OR, 0.98; 95% CI, 0.79-1.21). In our comparative efficacy analysis, no specific technology for increasing ADR was superior to others. We did not find significant differences between technologies in detection of advanced ADR, polyp detection rate, or mean number of adenomas/patient. CONCLUSIONS:In a network meta-analysis of published trials, we found that low-cost optimization of existing resources to be as effective as enhanced endoscopic imaging, or add-on devices, in increasing ADR during high-definition colonoscopy.

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“…Due to the high use of propofol at some hospitals, there may be endoscopists who have not performed colonoscopy under moderate sedation at all or for some time who would feel uncomfortable doing so. For these individuals, skills enhancement courses can be beneficial by providing strategies to minimise patient discomfort and improve caecal intubation and adenoma detection rates, such as by teaching torque steering and loop reduction, varying patient positioning to facilitate passage of the colonoscope,22–26 and use of carbon dioxide insufflation27–29 and water infusion techniques 30–32. Further recommendations made by the expert panel for improving patient experience under moderate sedation are provided in table 1.…”

Section: Discussionmentioning

confidence: 99%

Practice recommendations for the use of sedation in routine hospital-based colonoscopy

Dossa

Dubé

Tinmouth

et al. 2020

BMJ Open Gastroenterol

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ObjectiveAlthough sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice.DesignWe recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus.ResultsTwenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients.ConclusionThe recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.

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

Cited by 14 publications

References 6 publications

The Impact of the Colonoscopy Starting Position and Its Potential Outcomes

The Impact of the Colonoscopy Starting Position and Its Potential Outcomes

Compared Abilities of Endoscopic Techniques to Increase Colon Adenoma Detection Rates: A Network Meta-analysis

Practice recommendations for the use of sedation in routine hospital-based colonoscopy

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