Effect of Changing Patient’s Position During Colonoscopy to the Colonoscopy Time, Ileal Intubation Rate and Number of Polyps

Öz

Objective: Colonoscopy is universally considered as the conventional tool for the identification and removal of adenomatous polyps. The aim was to evaluate the effect of position change on the cecal and ileal intubation rates and the detection rate of polyps. In this way, it is aimed to accelerate the colonoscopy procedure time and increase its sensitivity. Methods: The study included 943 patients aged between 17 and 90 years presented for a diagnostic colonoscopy at our hospital surgery clinic from January 2008 to December 2018. Results: The results indicated significantly lower median cecal and ileal intubation time and higher polyps detection rate owing to change in the patient’s posture to supine than in the left lateral position during colonoscopy procedure (p<0.0001). Moreover, cecal (p<0.0001) and ileal (p=0.001) intubation time was negatively correlated with the number of polyps detected. The age of the participating patients was the demographic factor found to be positively correlated with the number of polyps detected (p<0.0001). Furthermore, changing the patient’s posture to supine led to an 11% increase in the polyp detection rate in the cecum, ascending colon, and hepatic flexure combined regions (p<0.0001). The odds of detection of polyps in this region were 2.11 (95%CI, 1.60-2.78) times higher in supine posture compared to the left lateral position. Conclusion: The above findings strengthen the relevance of the position of the patient in the polyp detection rate during colonoscopy procedures.

Anahtar Kelimeler

• Colonoscopy
• Cecal Intubation Rate
• Ileal İntubation Rate
• Colorectal Cancer
• Left Lateral Position
• Supine Position

Kolonoskopi Sırasında Hasta Pozisyonunun Değiştirilmesinin Kolonoskopi Süresi, İleal Entübasyon Oranı Ve Polip Sayısına Etkisi

Öz

Amaç: Kolonoskopi, adenomatöz poliplerin tanımlanması ve çıkarılması için tüm dünyada sık kullanılan yöntem olarak kabul görmektedir. Çalışmamızda, pozisyon değişikliğinin çekal ve ileal entübasyon oranlarına ve polip saptanma oranlarına etkisinin değerlendirilmesi amaçlandı. Bu sayede kolonoskopi işlem süresinin hızlandırılması ve hassasiyetinin arttırılması hedeflenmektedir. Yöntem: Çalışmaya Ocak 2008 ile Aralık 2018 tarihleri arasında hastanemiz cerrahi kliniğine tanısal kolonoskopi için başvuran 17-90 yaş arası 943 hasta dahil edildi. Bulgular: Sonuçlar, kolonoskopi işlemi sırasında sol lateral pozisyona göre hastanın sırtüstü duruşundaki değişiklik nedeniyle ortalama çekal ve ileal entübasyon sürelerinin anlamlı derecede daha düşük olduğunu ve polip saptama oranının daha yüksek olduğunu saptadık (p<0.0001). Ayrıca çekal (p<0.0001) ve ileal (p=0.001) entübasyon süreleri ile saptanan polip sayısı arasında negatif korelasyon olduğu görüldü. Dahil edilen hastaların yaşı ile tespit edilen polip sayıları arasında pozitif korelasyon olduğu izlendi (p<0.0001). Ayrıca, hastanın duruşunu sırtüstü olarak değiştirmek, çekum, çıkan kolon ve hepatik fleksur kombine bölgelerinde polip saptama oranında %11’lik bir artışa yol açtığı tespit edildi (p<0.0001). Bu bölgede polip saptanma olasılığı, sırtüstü pozisyonda sol yan pozisyona göre 2,11 (%95 GA, 1,60-2,78) kat daha yüksek olarak belirlendi. Sonuç: Yukarıdaki bulgular, kolonoskopi işlemleri sırasında polip saptanma oranında hastanın pozisyonunun önemini güçlendirmektedir.

Anahtar Kelimeler

• Kolonoskopi
• Çekal Entübasyon Oranı
• İleal Entübasyon Oranı
• Kolorektal Kanser
• Sol Yan Pozisyon
• Sırtüstü Pozisyon

Kaynakça

1. Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, Van Ballegooijen M, Kuntz KM. Evaluating test strategies for colorectal cancer screening: a decision analysis for the US Preventive Services Task Force. Ann Intern Med 2008; 149: 659-669.
2. Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M, Italian Multicentre Study Group. Italian Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut 2001; 48: 812-815.
3. Thiis-Evensen E, Hoff GS, Sauar J, Langmark F, Majak BM, Vatn MH. Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol 1999; 34: 414-420.
4. Bowles CJ, Leicester R, Romaya C, Swarbrick E, Williams CB, Epstein O. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut 2004; 53: 277-283.
5. Anderson JC, Gonzalez JD, Messina CR, Pollack BJ. Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol 2000; 95: 2784-2787.
6. Kim S, Kim H, Park H. Adverse events related to colonoscopy: Global trends and future challenges. Wor J Gastroenter 2019; 25: 190-204.
7. Shah SG, Brooker JC, Thapar C, Suzuki N, Williams CB, Saunders BP. Effect of magnetic endoscope imaging on patient tolerance and sedation requirements during colonoscopy: a randomized controlled trial. Gastrointest Endosc 2002; 55: 832-837.
8. Haycock A, Koch AD, Familiari P. Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training. Gastrointest Endosc 2010; 71: 298-307.

9. Sunada K, Shinozaki S, Yano T. Double-balloon colonoscopy has a higher cecal intubation rate than conventional colonoscopy using a colon simulator. Dig Dis Sci 2017; 62: 979-983.
10. Hafner S, Zolk K, Radaelli F, Otte J, Rabenstein T, Zolk O. Water infusion versus air insufflation for colonoscopy. Cochrane Database Syst Rev 2015; CD009863.
11. Ou G, Kim E, Lakzadeh P. A randomized controlled trial assessing the effect of prescribed patient position changes during colonoscope withdrawal on adenoma detection. Gastrointest Endosc 2014; 80: 277-23.
12. Köksal AŞ, Kalkan IH, Torun S. A simple method to improve adenoma detection rate during colonoscopy: altering patient position. Can J Gastroenterol 2013; 27: 509-512.
13. Ball AJ, Johal SS, Riley SA. Position change during colonoscope withdrawal increases polyp and adenoma detection in the right but not in the left side of the colon: results of a randomized controlled trial. Gastrointest Endosc 2015; 82: 488-494.
14. Amano T, Nishida T, Shimakoshi H, Shimoda A, Osugi N, Sugimoto A, et al. Number of polyps detected is a useful indicator of quality of clinical colonoscopy. Endoscop Inter Open 2018; 6: 878-884.
15. Hewett D. Techniques and Technologies for Increasing Adenoma Detection at Colonoscopy: Seeing More With Blue. Gastroenterology 2019; 156: 2126-2128.
16. Fayad N, Kahi C. Quality Measures for Colonoscopy: A Critical Evaluation. Clin Gastroenterol Hepatol 2014; 12: 1973-1980.
17. Bond A, Sarkar S. New technologies and techniques to improve adenoma detection in colonoscopy. World J Gastrointest Endosc 2015; 7: 969.
18. East JE, Suzuki N, Arebi N. Position changes improve visibility during colonoscope withdrawal: a randomized, blinded, crossover trial. Gastrointest Endosc 2007; 65: 263-279.
19. Alex J, Shawinder S, Stuart A. Position change during colonoscope withdrawal increases polyp and adenoma detection in the right but not in the left side of the colon: results of a randomized controlled trial. Gastrointes Endosc 2015; 82: 488-494.
20. Adler A, Wegscheider K, Lieberman D, Aminalai A, Aschenbeck J, Drossel R, et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates from 12 134 examinations. Gut 2013; 62: 236-241.
21. East JE, Bassett P, Arebi N, Thomas-Gibson S, Guenther T, Saunders BP. Dynamic position changes during colonoscope withdrawal increase adenoma detection: A randomized, crossover trial. Gastrointest Endosc 2011; 73: 456-463.