Position change during colonoscopy improves caecal intubation rate, mucosal visibility, and adenoma detection in patients with suboptimal caecal preparation

Abstract

IntroductionMost colonoscopies are completed in the left lateral (LL) position but in cases of suboptimal caecal preparation, changing the patient’s position to supine (S) and, if needed, to right lateral (RL) improves caecal intubation rate, mucosal visibility, and adenoma detection.AimTo determine if position change during colonoscopy facilitates optimal visualisation of the caecum.Material and methodsA total of 359 patients were grouped into three categories based on the initial caecal intubation position. After caecal intubation, caecal visibility was scored on a four-point scale depending on the number of imaginary quadrants of the caecum completely visualized – Arya Caecal Prep Score. A score of 1 or 2 was unsatisfactory, while 3 or 4 was considered satisfactory. In patients with unsatisfactory score, position was changed from LL to S and then RL and visibility was scored again.ResultsThe initial caecal intubation in the LL position was achieved in 66.8% of patients, S in 28.5%, and RL in 4.8% of patients. 84.5% (300/355) of patients had an acceptable visualisation score at the initial caecal intubation position. Of the 55 patients with unsatisfactory caecum visualisation scores in the initial intubation position, 30 (8.5%) had satisfactory scores after the first position change (95% CI: 5.77–11.84). Twenty-five (7.04%) subjects required two position changes (95% CI: 4.61–10.22%). An additional 9.3% (11/118) of adenomas were detected in caecum and ascending colon following position change.ConclusionsChanging patient position improves caecal intubation rate, mucosal visibility, and adenoma detection.

The Relationship Between Colonoscopy Practice Style, Operator Ergonomics and Procedure Quality

“…When compared to the other two styles, the relatively high number of maneuvers to correct/reposition the endoscope, the number of patient position changes during the procedure, and post-procedure endoscopist fatigue support this argument. Various studies have shown that changing the patient's position during the procedure contributes positively to ADR [17][18][19]. Undoubtedly, all these maneuvers would lead to extra operator fatigue.…”

State of the Science on Quality Indicators for Colonoscopy and How to Achieve Them

“…Understanding the reason for incomplete cecal intubation may help guide the particular approach in subsequent attempts (36). There are also patient factors that may hinder the ability to reach the cecum, including low body mass index, history of hysterectomy, bowel preparation quality, anatomy, inflammation, and obstruction (37)(38)(39)(40)(41). Withdrawal time: WT, the time measured from when the colonoscope reaches the cecum to the time the scope is withdrawn from the anus in the absence of polyp removal, has also been studied as a quality metric in colonoscopy.…”

Management of Periappendiceal Orifice Polyps

“…This is best performed under water immersion, with the use of a distal attachment/cap and by rolling the patient out of the left lateral decubitus position (in most patients, the cecum is best examined with the patient in the right lateral decubitus position). 7…”