Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial

BackgroundColonoscopy 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.ObjectiveTo assess whether position changes also improve adenoma and polyp detection.DesignRandomized crossover clinical trial.SettingAcademic endoscopy unit.PatientsThis study involved 130 patients who presented for routine colonoscopy.InterventionExamination 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 MeasurementsProportion 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.ResultsAt 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).LimitationsSingle-operator study.ConclusionDynamic position changes during colonoscope withdrawal significantly improved polyp and adenoma detection. (Clinical trial registration number: NCT00234650)