Document Detail


Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial.
MedLine Citation:
PMID:  20950801     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Colonoscopy has a miss rate for adenomas that may partly relate to poor visualization of the colonic surface. Dynamic position changes during colonoscope withdrawal can improve luminal distension.
OBJECTIVE: To assess whether position changes also improve adenoma and polyp detection.
DESIGN: Randomized crossover clinical trial.
SETTING: Academic endoscopy unit.
PATIENTS: This study involved 130 patients who presented for routine colonoscopy.
INTERVENTION: Examination either entirely in the left lateral position followed by position changes (cecum to hepatic flexure, left lateral; transverse colon, supine; splenic flexure and descending colon, right lateral) or vice versa. After both examinations, polyps were removed for histopathology.
MAIN OUTCOME MEASUREMENTS: Proportion of patients with ≥1 polyp or adenoma detected between the hepatic flexure and the sigmoid-descending colon junction. Luminal distension was measured on a scale of 1 to 5: 1, total collapse; 5, fully distended.
RESULTS: At least 1 adenoma was detected in 34% of patients in colon areas in which the patient position differed from left lateral (transverse colon, splenic flexure, descending colon) compared with 23% examined with the patient in the left lateral position alone (P = .01). At least 1 polyp was detected in 52% of patients with position changes versus 34% of patients examined in the left lateral position alone (P < .001). Adenoma and polyp detection were positively correlated with an improved distension score (correlation coefficient, 0.12; P < .001). Adenomas were detected in 16% of colon areas with adequate distension scores (4 and 5) compared with 7% of those with borderline or nondiagnostic scores (1-3; P < .001).
LIMITATIONS: Single-operator study.
CONCLUSION: Dynamic position changes during colonoscope withdrawal significantly improved polyp and adenoma detection. (Clinical trial registration number: NCT00234650).
Authors:
James E East; Paul Bassett; Naila Arebi; Siwan Thomas-Gibson; Thomas Guenther; Brian P Saunders
Publication Detail:
Type:  Journal Article     Date:  2010-10-15
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  73     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  456-63     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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