Comparison of left versus right lateral starting position on colonoscopy: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background Modifying patient position during colonoscopy has been proposed as a simple and inexpensive technique to increase luminal distention and improve navigation through the large bowel. The left lateral (LL) decubitus starting position is commonly used during colonoscopy. However, reports indicate that other starting positions may offer additional benefit. We aimed to determine if the right lateral (RL) starting position compared to the standard LL starting position could improve outcomes in colonoscopy. Methods We searched PubMed, Medline, and EMBASE through June 2020 to identify studies comparing RL and LL starting positions during colonoscopy. The primary outcomes included mean cecal insertion time and cecal intubation rate, and adverse events were assessed by pooling data using a random-effects model expressed in terms of odds ratio (OR), mean difference, and 95% confidence interval (CI). Results We identified 5 randomized controlled trials, including 809 participants, that compared LL vs. RL colonoscopy. The pooled OR for cecal intubation rate was 1.3 (95%CI 0.8-2.3; P=0.3). The mean difference in mean cecal insertion time was 0.08 (95%CI -0.09 to 0.26; P=0.4). Heterogeneity between studies was low ( I 2 =0%). No complications were reported in either arm of the study. Pain scores assessed using a visual analog scale were comparable among both arms of the study. Conclusion The RL starting position for colonoscopy was comparable to the LL and offered no additional benefit in terms of cecal intubation time, intubation rate, or patient discomfort.

Cap-assisted colonoscopy can increase the rate of sessile serrated lesion detection at the left lateral decubitus position: A retrospective case-control study

“…Two recent investigations of the starting position during colonoscopy did not identify a position that was more useful than the left lateral position. [19,20] Although other reports mentioned that the use of dynamic patient position changes during colonoscope' withdrawal increased the adenoma detection rate, [21,22] Nutalapati et al showed no significant difference in the polyp detection rate with the use of dynamic patient position changes. [23] Changing the patient's position during the withdrawal phase in colonoscopy is not currently a routine practice, for reasons that include difficulty in moving patients who are sedated with propofol, patients who are overweight, and limitations in both time and manpower.…”

“…Two recent investigations of the starting position during colonoscopy did not identify a position that was more useful than the left lateral position. [ 19 , 20 ] Although other reports mentioned that the use of dynamic patient position changes during colonoscope’ withdrawal increased the adenoma detection rate, [ 21 , 22 ] Nutalapati et al showed no significant difference in the polyp detection rate with the use of dynamic patient position changes. [ 23 ]…”

Colonoscopy: body and psyche. Can psychiatry contribute to the quality of the examination?

“…Carbon dioxide insufflation has been shown to reduce patient pain during and after colonoscopy compared with the use of air [61]. In contrast, no clinically significant differences were found for examinations: performed in the morning and afternoon [75]; started on the right or left lateral position [76]; performed in patients listening to music before and during the examination or without listening to music [77].…”

“…Wykazano, że wdmuchiwanie dwutlenku węgla do jelit zmniejsza ból pacjenta w trakcie i po kolonoskopii w porównaniu z użyciem do tego celu powietrza [61]. Natomiast nie znaleziono istotnych klinicznie różnic jeśli chodzi o badania: wykonywane rano i popołudniu [75]; rozpoczynane na prawym lub lewym boku [76]; przeprowadzane u pacjentów, słuchających muzyki przed i w trakcie badania lub bez słuchania muzyki [77].…”

Patient Position in Operative Endoscopy

“…The wall of the intestinal viscera can be compressed by the surrounding organs, and this can vary with the patient's decubitus position. As an example, modifying the patient's position during colonoscopy has been proposed as a simple and inexpensive technique to increase luminal distention [12].…”