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Objective: One of the most common technical difficulties during colonoscopy is passing through the fold of the sigmoid colon. Colonoscopy is commonly performed by endoscopists with the patient in the left lateral position. When the procedure is initiated in the left lateral position, insufflation of the bowel may result in a sharper angulation of the sigmoid colon, making advancement of the colonoscope more difficult. This study aimed to compare colonoscopic procedures initiated in the left lateral position and the supine position.
Materials and Methods: Colonoscopy was performed on 198 participants who had an indication for colonoscopy at the General Surgery clinic and met the study inclusion criteria. All procedures were conducted by the same endoscopist (Dr. Semra Tutcu Åžahin) in the Endoscopy Unit during working hours. Participants were randomly assigned to two groups:
Group 1: Participants whose starting position for colonoscopy was supine (n=97) Group 2: Participants whose starting position for colonoscopy was left lateral (n=101)
During colonoscopy, participants' demographic data, vital signs, and the time required for the endoscopist to reach the cecum were recorded. At the end of the procedure, participants completed a pain scale, and the endoscopist completed an observation scale. The data were entered into the SPSS program and analyzed.
Objective: One of the most common technical difficulties during colonoscopy is passing through the fold of the sigmoid colon. Colonoscopy is commonly performed by endoscopists with the patient in the left lateral position. When the procedure is initiated in the left lateral position, insufflation of the bowel may result in a sharper angulation of the sigmoid colon, making advancement of the colonoscope more difficult. This study aimed to compare colonoscopic procedures initiated in the left lateral position and the supine position.
Materials and Methods: Colonoscopy was performed on 198 participants who had an indication for colonoscopy at the General Surgery clinic and met the study inclusion criteria. All procedures were conducted by the same endoscopist (Dr. Semra Tutcu Åžahin) in the Endoscopy Unit during working hours. Participants were randomly assigned to two groups:
Group 1: Participants whose starting position for colonoscopy was supine (n=97) Group 2: Participants whose starting position for colonoscopy was left lateral (n=101)
During colonoscopy, participants' demographic data, vital signs, and the time required for the endoscopist to reach the cecum were recorded. At the end of the procedure, participants completed a pain scale, and the endoscopist completed an observation scale. The data were entered into the SPSS program and analyzed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Supine position (SP) | Other | The first group consisted of patients assigned to the supine position (SP) as the initial position for colonoscopy |
|
| Lateral Left Horizontal Position (LLP) | Other | The second group consisted of patients assigned to the left lateral horizontal position (LLP) as the initial position for colonoscopy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Colonoscopy after bowel cleansing | Procedure | Colonoscopy after bowel cleansing |
|
| Measure | Description | Time Frame |
|---|---|---|
| Cecal intubation time | Time (in seconds) from insertion of the colonoscope at the anal verge to successful cecal intubation, defined by visualization of the appendiceal orifice and ileocecal valve, recorded by the endoscopist. | During the colonoscopy procedure |
| Measure | Description | Time Frame |
|---|---|---|
| Pain score during colonoscopy | Pain intensity assessed immediately after the procedure using a 10-point Visual Analog Scale (VASP), where 0 indicates no pain and 10 indicates worst imaginable pain. | Immediately after colonoscopy |
| Endoscopist-rated procedure difficulty |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Manisa Celal Bayar University | Manisa | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38507105 | Background | McKechnie T, Heimann L, Kazi T, Jessani G, Lee Y, Sne N, Hong D, Eskicioglu C. Starting position during colonoscopy: a systematic review and meta-analysis of randomized controlled trials. Tech Coloproctol. 2024 Mar 20;28(1):39. doi: 10.1007/s10151-024-02912-8. | |
| 34475741 | Background | Ramai D, Singh J, Brooks OW, Barakat M, Mohan BP, Chandan S, Khan SR, Dhindsa B, Dhaliwal A, Ofosu A, Adler DG. Comparison of left versus right lateral starting position on colonoscopy: a systematic review and meta-analysis of randomized controlled trials. Ann Gastroenterol. 2021 Sep-Oct;34(5):699-704. doi: 10.20524/aog.2021.0639. Epub 2021 Jun 3. |
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Anonymized study results
Beginning 1 month after publication with no end date
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| Colonoscopy after bowel cleansing | Device | COLONOSCOPY WITH LEFT LATERAL AND SUPINE POSITION |
|
Procedure difficulty assessed immediately after colonoscopy using a 4-point Likert scale (1 = very easy, 2 = easy, 3 = difficult, 4 = very difficult), as rated by the endoscopist. |
| Immediately after colonoscopy |
| Changes in vital signs during colonoscopy | Heart rate (beats per minute) measured at baseline and at 5-minute intervals during the procedure. The maximum change from baseline will be recorded. | During the colonoscopy procedure |
| 32617389 | Background | Watanabe J, Park D, Kakehi E, Inoue K, Ishikawa S, Kataoka Y. Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis. Endosc Int Open. 2020 Jul;8(7):E848-E860. doi: 10.1055/a-1149-1541. Epub 2020 Jun 16. |
| 34563640 | Background | Li N, Lu B, Luo C, Cai J, Lu M, Zhang Y, Chen H, Dai M. Incidence, mortality, survival, risk factor and screening of colorectal cancer: A comparison among China, Europe, and northern America. Cancer Lett. 2021 Dec 1;522:255-268. doi: 10.1016/j.canlet.2021.09.034. Epub 2021 Sep 24. |
| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| D003110 | Colonic Neoplasms |
| D003111 | Colonic Polyps |
| ID | Term |
|---|---|
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |
| D007417 | Intestinal Polyps |
| D011127 | Polyps |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
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