Colonoscopy (Procedure)
Conditions
Keywords
Endoscopist ergonomics, Cecal intubation time, Patient positioning
Brief summary
The main questions it aims to answer are: Does starting colonoscopy in the supine position compared with the left lateral position affect the time required to reach the cecum? Does the starting position affect endoscopist comfort, patient comfort, procedure duration, polyp and adenoma detection, or the need to change the patient's position during the procedure? Participants will be randomly assigned to undergo colonoscopy starting either in the supine position or in the left lateral position. The colonoscopy will otherwise be performed according to standard clinical practice.
Detailed description
Colonoscopy is widely used for the diagnosis, screening, and surveillance of colorectal diseases. The left lateral position is conventionally used as the initial patient position during colonoscopy; however, alternative starting positions may influence colonoscope advancement, procedure efficiency, and the comfort of both the patient and the endoscopist. This single-center, randomized controlled trial was designed to evaluate the effect of the starting position on colonoscopy efficiency. Adult participants undergoing elective colonoscopy were randomly assigned in a 1:1 ratio to begin the procedure either in the supine position or in the left lateral position. The primary focus of the study was endoscopist comfort during the procedure. Additional assessments included patient comfort, cecal intubation time, withdrawal time, adenoma and polyp detection, the need for patient repositioning during colonoscopy, and procedure-related complications. The study aimed to determine whether the supine starting position provides advantages over the conventional left lateral starting position and whether the initial patient position may represent a simple and readily applicable factor for improving colonoscopy efficiency.
Interventions
PROCEDUREColonoscopy Starting Position
Participants were assigned to undergo colonoscopy starting either in the supine position or in the left lateral position according to randomization. The assigned position was used at the beginning of the procedure. Patient repositioning during colonoscopy was permitted when clinically required to facilitate colonoscope advancement or completion of the procedure.
Sponsors
Sisli Hamidiye Etfal Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults aged 18 years or older. Scheduled to undergo screening colonoscopy. No history of colorectal cancer. No history of colorectal surgery.
Exclusion criteria
Failure to achieve cecal intubation. Inflammatory bowel disease. Inadequate bowel preparation, defined as a Boston Bowel Preparation Scale (BBPS) score \<2.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Endoscopist Comfort Score (ECS) | Immediately after completion of the colonoscopy | Endoscopist comfort was assessed using a 100-mm visual analog scale (VAS), converted to a 0-10 numeric score, with higher scores indicating greater comfort. |
| Patient Comfort Score (PCS) | After recovery from anesthesia on the day of the colonoscopy | Patient comfort was assessed using a 100-mm visual analog scale (VAS), converted to a 0-10 numeric score, with higher scores indicating greater comfort. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cecal Intubation Time (CIT) | During the colonoscopy, from colonoscope insertion to cecal intubation | Cecal intubation time was defined as the time from insertion of the colonoscope at the anal verge to visualization of characteristic cecal landmarks, such as the appendiceal orifice or ileocecal valve. Time was measured using a chronometer and recorded in minutes. |
| Withdrawal Time (WT) | During the colonoscopy | Withdrawal time was defined as the time from the start of colonoscope withdrawal at the cecum to withdrawal of the colonoscope at the rectum. The durations of polypectomy and other therapeutic interventions performed during withdrawal were included in the withdrawal time. Time was measured using a chronometer and recorded in minutes. |
| Adenoma Detection Rate (ADR) | Up to 30 days after colonoscopy | Adenoma detection rate was defined as the percentage of participants in whom at least one histologically confirmed adenoma was detected during colonoscopy. Histological confirmation was based on pathology reports. |
| Polyp Detection Rate (PDR) | During the colonoscopy | Polyp detection rate was defined as the percentage of participants in whom at least one polyp was detected during colonoscopy. |
| Requirement for Patient Repositioning | During the colonoscopy | Patient repositioning was defined as the requirement for an assisted transition from the assigned initial starting position to a different patient position during colonoscopy. The outcome was recorded as whether repositioning was required or not required. |
| Requirement for Abdominal Compression | During the colonoscopy | Abdominal compression was defined as the requirement for manual pressure applied to the abdominal wall to facilitate advancement of the colonoscope. The outcome was recorded as whether abdominal compression was required or not required. |
| Procedure-Related Complications | During and after the colonoscopy on the day of the procedure | Procedure-related complications included perforation, clinically significant bleeding or abdominal pain requiring hospitalization, and hypoxemia or hypotension requiring hospitalization. The outcome was assessed as the proportion of participants experiencing at least one of these complications. |
Countries
Turkey (Türkiye)
Outcome results
None listed