Seung-Woo Lee1, Jae Hyuck Chang2, Jeong-Seon Ji3, Il Ho Maeong2, Dae Young Cheung4, Joon Sung Kim3, Young-Seok Cho5, Wook-Jin Chung6, Bo-In Lee5, Sang-Woo Kim7, Byung-Wook Kim3, Hwang Choi3, Myung-Gyu Choi5. 1. Department of Internal Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea. 2. Department of Internal Medicine, Bucheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea. 3. Division of Gastroenterology, Department of Internal Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea. 4. Department of Internal Medicine, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 5. Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 6. Department of Internal Medicine, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon, Republic of Korea. 7. Departments of Internal Medicine, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.
Abstract
OBJECTIVES: Adequate luminal distension is essential for improving adenoma detection during colonoscope withdrawal. A few crossover studies have reported that dynamic position changes maximize luminal distension and increase adenoma detection rates (ADR). We designed a multicenter, randomized, parallel-group trial to verify the effect of dynamic position changes on colonic adenoma detection. METHODS: This study was conducted at the six hospitals of the Catholic University of Korea. Patients aged 45-80 years who underwent a colonoscopy for the first time were included. In the position change group, the position changes during colonoscope withdrawal were as follows: cecum, ascending colon, and hepatic flexure: left lateral position; transverse colon: supine position; splenic flexure, descending colon, sigmoid colon, and rectum: right lateral position. In the control group, the examinations were performed entirely in the left lateral position during colonoscope withdrawal. The primary outcome measure was the ADR, which was defined as the proportion of patients with ≥1 adenoma. RESULTS: A total of 1,072 patients were randomized into the position change group (536 patients) or the control group (536 patients). The ADR was higher in the position change group than in the control group (42.4 vs. 33.0%, P=0.002). More adenomas were detected per subject in the position change group (0.90 vs. 0.67, P=0.01). Increases in the number of adenomas were observed in examinations of the transverse colon (0.22 vs. 0.13, P=0.016) and the left colon (0.37 vs. 0.27, P=0.045). A significant increase in the ADR was observed for endoscopists with a relatively low detection rate. For endoscopists with a high detection rate, non-significant changes in the ADR were observed. CONCLUSIONS:Dynamic position changes during colonoscope withdrawal increased the ADR.
RCT Entities:
OBJECTIVES: Adequate luminal distension is essential for improving adenoma detection during colonoscope withdrawal. A few crossover studies have reported that dynamic position changes maximize luminal distension and increase adenoma detection rates (ADR). We designed a multicenter, randomized, parallel-group trial to verify the effect of dynamic position changes on colonic adenoma detection. METHODS: This study was conducted at the six hospitals of the Catholic University of Korea. Patients aged 45-80 years who underwent a colonoscopy for the first time were included. In the position change group, the position changes during colonoscope withdrawal were as follows: cecum, ascending colon, and hepatic flexure: left lateral position; transverse colon: supine position; splenic flexure, descending colon, sigmoid colon, and rectum: right lateral position. In the control group, the examinations were performed entirely in the left lateral position during colonoscope withdrawal. The primary outcome measure was the ADR, which was defined as the proportion of patients with ≥1 adenoma. RESULTS: A total of 1,072 patients were randomized into the position change group (536 patients) or the control group (536 patients). The ADR was higher in the position change group than in the control group (42.4 vs. 33.0%, P=0.002). More adenomas were detected per subject in the position change group (0.90 vs. 0.67, P=0.01). Increases in the number of adenomas were observed in examinations of the transverse colon (0.22 vs. 0.13, P=0.016) and the left colon (0.37 vs. 0.27, P=0.045). A significant increase in the ADR was observed for endoscopists with a relatively low detection rate. For endoscopists with a high detection rate, non-significant changes in the ADR were observed. CONCLUSIONS: Dynamic position changes during colonoscope withdrawal increased the ADR.
Authors: David A Lieberman; Douglas K Rex; Sidney J Winawer; Francis M Giardiello; David A Johnson; Theodore R Levin Journal: Gastroenterology Date: 2012-07-03 Impact factor: 22.682
Authors: Douglas K Rex; John L Petrini; Todd H Baron; Amitabh Chak; Jonathan Cohen; Stephen E Deal; Brenda Hoffman; Brian C Jacobson; Klaus Mergener; Bret T Petersen; Michael A Safdi; Douglas O Faigel; Irving M Pike Journal: Am J Gastroenterol Date: 2006-04 Impact factor: 10.864
Authors: Praveen T Rajasekhar; Colin J Rees; Mike G Bramble; Douglas W Wilson; Matthew D Rutter; Brian P Saunders; A Pali S Hungin; James E East Journal: Endoscopy Date: 2015-02-12 Impact factor: 10.093
Authors: Thomas J W Lee; Matthew D Rutter; Roger G Blanks; Sue M Moss; Andrew F Goddard; Andrew Chilton; Claire Nickerson; Richard J Q McNally; Julietta Patnick; Colin J Rees Journal: Gut Date: 2011-09-22 Impact factor: 23.059
Authors: Nancy N Baxter; Rinku Sutradhar; Shawn S Forbes; Lawrence F Paszat; Refik Saskin; Linda Rabeneck Journal: Gastroenterology Date: 2010-09-18 Impact factor: 22.682
Authors: J G Fletcher; C D Johnson; T J Welch; R L MacCarty; D A Ahlquist; J E Reed; W S Harmsen; L A Wilson Journal: Radiology Date: 2000-09 Impact factor: 11.105
Authors: George Ou; Edward Kim; Pardis Lakzadeh; Jessica Tong; Robert Enns; Alnoor Ramji; Scott Whittaker; Hin Hin Ko; Brian Bressler; Lawrence Halparin; Eric Lam; Jack Amar; Jennifer Telford Journal: Gastrointest Endosc Date: 2014-03-12 Impact factor: 9.427
Authors: Ma Henar Núñez Rodríguez; Pilar Díez Redondo; Fausto Riu Pons; Marta Cimavilla; Luis Hernández; Andrea Loza; Manuel Pérez-Miranda Journal: United European Gastroenterol J Date: 2020-05-07 Impact factor: 4.623
Authors: Maria MacDonald; Alison Greene; Mark Borgaonkar; Nicholas A Fairbridge; Jerry McGrath; Chris Smith; Chantae Garland; Lisa Bacque; David Pace Journal: Surg Endosc Date: 2022-01-18 Impact factor: 3.453