Prone Positioning of Obese Patients for Colonoscopy Results in Shortened Cecal Intubation Times: A Randomized Trial

Abstract

Performance of colonoscopy in the prone position for obese patients results in significantly shorter cecal intubation times and decreased need for patient repositioning. Prone positioning is well accepted and does not significantly increase procedure-related discomfort.

Right Or Left in COLonoscopy (ROLCOL)? A Randomized Controlled Trial of Right- versus Left-Sided Starting Position in Colonoscopy

“…Previous studies have shown that an ~20% diff erence in procedure time can be achieved by a change in starting position ( 3 ). Mean time to reach the cecum has been reported as 6.4 min with s.d.…”

“…Uddin et al ( 3 ) conducted a randomized trial of obese patients and found benefi t in starting the procedure in the prone position compared with LL positions. No trial to date has compared right with left -sided positioning with respect to cecal intubation time or patient comfort.…”

Colonoscopy in Obese Patients: Time to Change Position

“…A recent study in which abdominal compression obtained with a fitted corset facilitates colonoscopy reported that extra abdominal compression and a change of position was used less frequently in the study subjects accompanied by less procedural pain [21]. In contrast, no definite data are available on the effect of a change from standard left lateral decubitus to prone position in facilitating colonoscopy in obese patients.This number of Digestive Diseases and Sciences includes a prospective randomized trial by Uddin and colleagues [22] which reports for the first time that starting sedated colonoscopy in prone position for male obese subjects (BMI [ 30 kg/ m 2 ) significantly shortens cecal intubation times with less need for patient repositioning. Additionally, the authors reported no differences in subjects' perception of pain or their willingness to repeat the procedure when compared with obese subjects in whom the exploration was started using the standard left decubitus position.…”

“…This number of Digestive Diseases and Sciences includes a prospective randomized trial by Uddin and colleagues [22] which reports for the first time that starting sedated colonoscopy in prone position for male obese subjects (BMI [ 30 kg/ m 2 ) significantly shortens cecal intubation times with less need for patient repositioning. Additionally, the authors reported no differences in subjects' perception of pain or their willingness to repeat the procedure when compared with obese subjects in whom the exploration was started using the standard left decubitus position.…”

“…Even if some safety aspects regarding deep sedation administered by non-anesthesiologists in prone subjects remain unresolved, the original article included in this issue of Digestive Diseases and Sciences [22] constitutes a clear confirmation of how a simple, inexpensive, and easily reproducible measure can improve colonoscopy performance in obese patients. From these results, we should reconsider whether it is time to change patients' position towards easier, but efficient procedures.…”