title: A randomized controlled trial assessing the effect of prescribed patient position changes during colonoscope withdrawal on adenoma detection.
abstract: BACKGROUND
  High-quality colonoscope withdrawal technique is associated with a higher adenoma detection rate. Position change is routinely used in barium enema and CT colonography to facilitate adequate distension of the colon and promote movement of fluid from the segment of the colon being assessed.
  
  
  OBJECTIVE
  To determine whether prescribed position changes during colonoscope withdrawal affect the adenoma detection rate compared with the usual care per endoscopist.
  
  
  METHODS
  Prospective, randomized, controlled trial.
  
  
  METHODS
  Tertiary-care, university-affiliated hospital.
  
  
  METHODS
  Patients referred for outpatient colonoscopy between July 2011 and July 2012 were evaluated for eligibility. Inclusion criteria were outpatient status and age ≥40 years. Exclusion criteria were (1) complete colonoscopy within 1 year before the procedure, (2) inability to provide informed consent, (3) incomplete colonoscopy to the cecum, (4) previous bowel resection, (5) inflammatory bowel disease, (6) colonic polyposis syndrome, (7) inadequate bowel preparation, and (8) musculoskeletal disorder or other mobility issues limiting effective patient position changes during colonoscopy.
  
  
  METHODS
  Prescribed position changes during colonoscope withdrawal.
  
  
  METHODS
  Polyp detection rate (PDR) and adenoma detection rate (ADR).
  
  
  RESULTS
  A total of 776 patients were enrolled, with 388 in the dynamic group. There was no difference in PDR (odds ratio [OR] 0.99; P = .93) or ADR (OR 1.17; P = .28). Colonoscope withdrawal time was longer in the dynamic group (median time 466.5 vs 422.5 seconds; P < .0001).
  
  
  CONCLUSIONS
  Single-center study. Indication for procedure not controlled. Lack of standardized bowel preparation and blinding.
  
  
  CONCLUSIONS
  Prescribed position changes during colonoscope withdrawal do not affect polyp/adenoma detection compared with the usual practice when the baseline ADR is above the recommended standard. (
  
  
  BACKGROUND
  NCT01395173.).
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Ou
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Pardis
authors.initials: P
authors.lastname: Lakzadeh
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Tong
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Enns
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alnoor
authors.initials: A
authors.lastname: Ramji
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Whittaker
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Hin Hin
authors.initials: HH
authors.lastname: Ko
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Bressler
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Halparin
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Lam
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jack
authors.initials: J
authors.lastname: Amar
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Telford
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis*; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D020878:Device Removal; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011446:Prospective Studies; D013997:Time Factors