title: Position changes improve visibility during colonoscope withdrawal: a randomized, blinded, crossover trial.
abstract: BACKGROUND
  Adequate distension is essential to maximize neoplasia detection during colonoscope withdrawal. Position changes may improve distension but are often not performed in routine practice.
  
  
  OBJECTIVE
  To assess whether routine position changes improve luminal distension during colonoscope withdrawal.
  
  
  METHODS
  Randomized, blinded, crossover trial.
  
  
  METHODS
  Single tertiary-referral center, United Kingdom.
  
  
  METHODS
  Fourteen patients attending for routine colonoscopy.
  
  
  METHODS
  Videotaped, back-to-back examination of colon proximal to rectosigmoid junction in left lateral position only, then with position changes: left lateral for the cecum to the hepatic flexure, supine for the transverse colon, and right lateral for the splenic flexure and the descending colon, or vice versa.
  
  
  METHODS
  Luminal distension as scored by a blinded video reviewer. Luminal distension was scored on a scale of 1 to 5 for each colonic area: 1, complete collapse; 5, widely distended to limit of view. A score of 2 or less was considered inadequate for diagnosis.
  
  
  RESULTS
  Scores for the 2 examinations from the blinded video reviewer were significantly higher in the transverse, the splenic flexure, and the descending colon, P = .02, .002, and <.001, respectively. Without position changes, 6 of 14 of patients (43%) would have had a nondiagnostic distension score (1 or 2) in at least 1 colonic area, P = .03.
  
  
  CONCLUSIONS
  Nonvalidated scoring system for luminal distension, however, good agreement between endoscopist and blinded reviewer, weighted kappa 0.53, 95% confidence interval 0.38-0.69.
  
  
  CONCLUSIONS
  Position change, a cost-neutral intervention, during colonoscope withdrawal improved luminal distension between hepatic flexure and sigmoid-descending junction and has the potential to reduce adenoma and early cancer miss rates.
authors.affiliation: Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, Middlesex, UK.
authors.forename: James E
authors.initials: JE
authors.lastname: East
authors.forename: Noriko
authors.initials: N
authors.lastname: Suzuki
authors.forename: Naila
authors.initials: N
authors.lastname: Arebi
authors.forename: Paul
authors.initials: P
authors.lastname: Bassett
authors.forename: Brian P
authors.initials: BP
authors.lastname: Saunders
mesh_terms: D003106:Colon; D003113:Colonoscopy / Q000379:methods*; D018592:Cross-Over Studies; D006801:Humans; D011187:Posture; D016037:Single-Blind Method; D014743:Videotape Recording