title: Right Or Left in COLonoscopy (ROLCOL)? A Randomized Controlled Trial of Right- versus Left-Sided Starting Position in Colonoscopy.
abstract: OBJECTIVE
  Colonoscopy is technically challenging and can cause discomfort for patients. We aimed to test whether right-sided starting position for colonoscopy would result in shorter procedure time and greater patient comfort when compared with conventional left-sided starting position.
  
  
  METHODS
  We conducted a randomized controlled trial in which patients were randomized to begin in either the right- (RL) or conventional left-lateral (LL) position. One hundred and sixty-three adult patients undergoing scheduled colonoscopy were stratified by age, gender, body mass index, and experience of the endoscopist. Patients were then randomized 1:1 in permuted blocks. The primary outcome measure was time to cecal intubation and secondary outcome measures included patient comfort that was evaluated by visual analog comfort scale.
  
  
  RESULTS
  Median time to reach the cecum was quicker when colonoscopy began with patients positioned RL rather than LL (P=0.0078). Moreover, patients found RL more comfortable than LL (P=0.02). Multiple linear regression confirmed starting position in colonoscopy as an independent determinant of time to reach the cecum (P=0.007). Women and those who had previously undergone abdominal surgery gained the greatest benefit from right-sided positioning (RL vs. LL: 498 vs. 824 s; P=0.03 and 498 vs. 797 s; P=0.006, respectively).
  
  
  CONCLUSIONS
  Our study reveals that right-sided positioning at the start of colonoscopy results in more comfortable and quicker procedures. Of the factors identified by multiple linear regression to independently have an impact on time to reach the cecum, only starting position is modifiable. Right-sided starting position may therefore be of benefit in colonoscopy, in particular for women and patients who have previously undergone abdominal surgery.
authors.affiliation: Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Vergis
authors.affiliation: Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: McGrath
authors.affiliation: Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK.
authors.forename: C H
authors.initials: CH
authors.lastname: Stoddart
authors.affiliation: Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Hoare
mesh_terms: D002432:Cecum / Q000473:pathology; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007440:Intubation; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D056888:Patient Positioning; D057240:Patient Preference; D012737:Sex Factors; D013997:Time Factors