The Effectiveness of Right- vs Left-lateral Starting Position in Unsedated Diagnostic Colonoscopy with Modified-water Immersion Method: A Randomized Controlled Trial Study

The Effects of Positioning During Colonoscopy on Efficacy and Post-procedure Comfort

Background/Aims

There are studies with different results on improving effectiveness and patient comfort by increasing lumen distention through positioning during colonoscopy. In our study, we aimed to compare colonoscopy outcomes and post-procedural patient comfort in the left-lateral and right-lateral positions.

Materials and Methods

A total of 231 patients who underwent screening colonoscopy were included. Patients were randomized to either the left-lateral or the right-lateral position. Patient age, sex, comorbidities, body mass index (BMI) values, times to reach the cecum, ileum intubation rates, total procedure times, and colonoscopy findings were compared. Pain and discomfort after the procedure were evaluated and compared with the visual analog scale (VAS) scores at 30 minutes, 6 hours, and 24 hours.

Results

Colonoscopy was performed in the left-lateral position in 129 patients and in the right-lateral position in 102. The distributions of age, sex, comorbidities, and BMI values were similar in both groups. The time to reach the cecum and the total procedure time were similar in both groups. There were no significant differences in the findings detected by colonoscopy. There was no significant difference in the post-procedural VAS scores.

Conclusion

Starting position during colonoscopy: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Traditional teaching has been to place patients in the left lateral decubitus starting position for colonoscopies. Recent randomized controlled trials (RCTs) have compared left lateral decubitus starting position to other approaches. The aim of this systematic review and meta-analysis was to compare different starting positions for colonoscopies and their effect on cecal intubation.

METHODS

MEDLINE, Embase, and CENTRAL were searched from inception to July 2023. Articles were eligible for inclusion if they were RCTs comparing at least two different starting positions for adults undergoing colonoscopy. The main outcome was cecal intubation time. Meta-analysis used an inverse variance random effects model. Risk of bias was assessed with the Cochrane Tool for RCTs 2.0.

RESULTS

After screening 1523 citations, 14 RCTs were included. Four studies compared left lateral decubitus to right lateral decubitus, four studies compared left lateral decubitus to left lateral tilt-down, three studies compared left lateral decubitus to prone, and three studies compared left lateral decubitus to supine. There were no statistically significant differences in cecal intubation time in seconds across all comparisons: left lateral decubitus vs. right lateral decubitus (MD 14.9, 95% CI - 111.8 to 141.6, p = 0.82, I2 = 85%); left lateral decubitus vs. left lateral tilt-down (MD - 31.3, 95% CI - 70.8 to 8.3, p = 0.12, I2 = 82%); left lateral decubitus vs. prone (MD 17.2, 95% CI - 174.9 to 209.4, p = 0.86, I2 = 94%); left lateral decubitus vs. supine (MD - 149.9, 95% CI - 443.6 to 143.9, p = 0.32, I2 = 89%).

CONCLUSION

The starting position for colonoscopies likely does not influence cecal intubation time. This study was limited by heterogeneity.

Comparison of left versus right lateral starting position on colonoscopy: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Modifying patient position during colonoscopy has been proposed as a simple and inexpensive technique to increase luminal distention and improve navigation through the large bowel. The left lateral (LL) decubitus starting position is commonly used during colonoscopy. However, reports indicate that other starting positions may offer additional benefit. We aimed to determine if the right lateral (RL) starting position compared to the standard LL starting position could improve outcomes in colonoscopy.

METHODS

We searched PubMed, Medline, and EMBASE through June 2020 to identify studies comparing RL and LL starting positions during colonoscopy. The primary outcomes included mean cecal insertion time and cecal intubation rate, and adverse events were assessed by pooling data using a random-effects model expressed in terms of odds ratio (OR), mean difference, and 95% confidence interval (CI).

RESULTS

We identified 5 randomized controlled trials, including 809 participants, that compared LL vs. RL colonoscopy. The pooled OR for cecal intubation rate was 1.3 (95%CI 0.8-2.3; P=0.3). The mean difference in mean cecal insertion time was 0.08 (95%CI -0.09 to 0.26; P=0.4). Heterogeneity between studies was low (I 2=0%). No complications were reported in either arm of the study. Pain scores assessed using a visual analog scale were comparable among both arms of the study.

CONCLUSION

The RL starting position for colonoscopy was comparable to the LL and offered no additional benefit in terms of cecal intubation time, intubation rate, or patient discomfort.