title: The prone 12 o'clock position reduces ileal intubation time during colonoscopy compared to the left lateral 6 o'clock (standard) position.
abstract: BACKGROUND
  Ileal intubation is the gold standard for a complete colonoscopy. However, despite evidence of clinical benefit ileoscopy is not always attempted due to perceived technical difficulty. Our aim was to compare time taken for ileal intubation using a new position-the prone 12 o'clock position (PP) with the standard method (left lateral 6 o'clock position-LLP).
  
  
  METHODS
  We performed a pilot study using fluoroscopy to determine the best patient position for ileal intubation. This was the prone 12 o'clock position. Patients were colonoscoped in the left lateral position and then randomized to ileal intubation in the 6 o'clock position(LL) or the 12 o'clock (PP) position.
  
  
  RESULTS
  202 consecutive patients were referred for colonoscopy. Colonoscopy was performed on 150 patients [82 females, mean (SD) age 53 (16) years]. 75 patients were randomized for ileal intubation in the PP and 75 patients in the LLP. Overall, the ileum was successfully intubated in 145 (96%) patients [74 (98.7%) in the PP and 71 (94.7%) in the LLP]. The median (Interquartile Range) ileal intubation time was 12 (10) seconds in the PP and 87 (82) seconds in the LLP (p < 0.0001; Mann-Whitney U test). The ileum was abnormal in 11 (7.5%) patients.
  
  
  CONCLUSIONS
  During colonoscopy, the prone 12 o'clock position gives a more direct approach to the ileo-caecal valve and significantly reduces ileal intubation time.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  Sri Lanka Clinical Trial Registry Clinical trial registry number: SLCTR/2009/002.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. apdsilva@yahoo.com
authors.forename: Arjuna P
authors.initials: AP
authors.lastname: De Silva
authors.forename: Ravindu S
authors.initials: RS
authors.lastname: Kumarasena
authors.forename: Suramya D
authors.initials: SD
authors.lastname: Perera Keragala
authors.forename: Udaya
authors.initials: U
authors.lastname: Kalubowila
authors.forename: Madunil
authors.initials: M
authors.lastname: Niriella
authors.forename: Anuradha S
authors.initials: AS
authors.lastname: Dassanayake
authors.forename: Arunasalam
authors.initials: A
authors.lastname: Pathmeswaran
authors.forename: H Janaka
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007082:Ileum; D007440:Intubation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016684:Prone Position; D013997:Time Factors