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

Abstract

Our study reveals that right-sided positioning at the start of colonoscopy results in more comfortable and quicker procedures. Of the factors identified by multiple linear regression to independently have an impact on time to reach the cecum, only starting position is modifiable. Right-sided starting position may therefore be of benefit in colonoscopy, in particular for women and patients who have previously undergone abdominal surgery.

Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis

“…In the right lateral starting position, there were no complications [16,17]. In the supine starting position, 25 patients desaturated to < 90 %, nine patients needed increased oxygen supplementation, 33 patients had apnea and abnormal ventilation, 23 patients had bradycardia, and 6 patients had hypotension [19,20].…”

“…Four studies reported no AEs: one study in right lateral versus left lateral, one study in supine versus left lateral, one a study in prone versus left lateral, and one study in tilt-down versus left lateral starting position (▶ Fig. 4) [16,20,22,25]. In the other four studies, of the 11 participants (1.3 %) who required medication in the non-left lateral starting position, one had post-polypectomy bleeding in prone position and nine in supine and one in tilt-down had oxygen desaturation (< 90 %) requiring increased oxygen supplementation.…”

“…We summarized and described the studies in ▶ Table 1. We included 10 studies (with 2083 participants) that compared a starting position other than the left lateral with the left lateral starting position during colonoscopy [16][17][18][19][20][21][22][23][24][25].…”

“…Mean cecal insertion time for colonoscopy Eight studies were eligible for the evaluation of the mean cecal insertion time for colonoscopy [16,17,[20][21][22][23][24][25]. We identified two studies in right lateral versus left lateral position, one study in supine versus left lateral position, two studies in prone versus left lateral, and three studies in tilt-down versus left lateral position.…”

“…Mean score of the participant pain or discomfort Six studies were eligible for evaluation of the mean score of the participants' pain or discomfort [16,20,21,22,24,25]. We included one study in right versus left position, one study in supine versus left position, two studies in prone versus left position, and one study in tilt-down versus left position.…”