CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(12): E1842-E1849
DOI: 10.1055/a-1265-6634
Original article

Effect of dynamic position changes on adenoma detection rate during colonoscope withdrawal: systematic review and meta-analysis

Venkat Nutalapati
1   Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansa, United States
Madhav Desai
2   Department of Gastroenterology, Kansas City Veterans Medical Center, Kansas City, Kansas, United States
Vivek Sandeep Thoguluva-Chandrasekar
1   Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansa, United States
Mojtaba Olyaee
1   Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansa, United States
Amit Rastogi
1   Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansa, United States
› Author Affiliations


Background and study aims The adenoma detection rate (ADR) is an important quality metric of colonoscopy. Higher ADR correlates with lower incidence of interval colorectal cancer. ADR is variable between endoscopists and depends upon the withdrawal technique amongst other factors. Dynamic position change (lateral rotation of patients with a view to keep the portion of the colon being inspected at a higher level) helps with luminal distension during the withdrawal phase. However, impact of this on ADR is not known in a pooled sample. We performed a systematic review and meta-analysis to study the impact of dynamic position changes during withdrawal phase of colonoscopy on ADR

Methods A comprehensive search of MEDLINE, EMBASE, Google Scholar, and the Cochrane Database was conducted from each database’s inception to search for studies comparing dynamic position changes during colonoscope withdrawal with static left lateral position (control). The primary outcome of interest was ADR. Other studied outcomes were polyp detection rate (PDR) and withdrawal time. Outcomes were reported as pooled odds ratio (OR) with 95 % confidence intervals (CI) with statistical significance (P < 0.05). RevMan 5.3 software was used for statistical analysis.

Results Six studies were included in our analysis with 2860 patients. Of these, dynamic position change was implemented in 1177 patients while 1183 patients served as the controls. ADR was significantly higher in the dynamic position change group with pooled OR 1.36 (95 % CI, 1.15–1.61; P < 0.01). There was low heterogeneity in inclusion studies (I2 = 0 %). PDR was numerically higher in position change group (53.4 % vs 49.6 %) but not statistically significant (P = 0.16). Mean withdrawal time did not significantly change with dynamic position change (12.43 min vs 11.46 min, P = 0.27).

Conclusion Position change during the withdrawal phase of colonoscopy can increase the ADR compared to static left lateral position. This is an easy and practical technique that can be implemented to improve ADR.

Publication History

Received: 22 April 2020

Accepted: 03 August 2020

Article published online:
17 November 2020

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  • References

  • 1 Lieberman DA. Clinical practice. Screening for colorectal cancer. N Engl J Med 2009; 361: 1179-1187
  • 2 Baxter NN, Goldwasser MA, Paszat LF. et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med 2009; 150: 1-8
  • 3 Brenner H, Chang-Claude J, Seiler CM. et al. Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med 2011; 154: 22-30
  • 4 Rex DK, Cutler CS, Lemmel GT. et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997; 112: 24-28
  • 5 van Rijn JC, Reitsma JB, Stoker J. et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006; 101: 343-350
  • 6 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
  • 7 Lee RH, Tang RS, Muthusamy VR. et al. Quality of colonoscopy withdrawal technique and variability in adenoma detection rates (with videos). Gastrointest Endosc 2011; 74: 128-134
  • 8 Rex DK. Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc 2000; 51: 33-36
  • 9 East JE, Suzuki N, Arebi N. et al. Position changes improve visibility during colonoscope withdrawal: a randomized, blinded, crossover trial. Gastrointest Endosc 2007; 65: 263-269
  • 10 Chen SC, Lu DS, Hecht JR. et al. CT colonography: value of scanning in both the supine and prone positions. AJR Am J Roentgenol 1999; 172: 595-599
  • 11 Ou G, Kim E, Lakzadeh P. et al. A randomized controlled trial assessing the effect of prescribed patient position changes during colonoscope withdrawal on adenoma detection. Gastrointest Endosc 2014; 80: 277-283
  • 12 East JE, Bassett P, Arebi N. et al. Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial. Gastrointest Endosc 2011; 73: 456-463
  • 13 Koksal AS, Kalkan IH, Torun S. et al. A simple method to improve adenoma detection rate during colonoscopy: altering patient position. Can J Gastroenterol 2013; 27: 509-512
  • 14 Moher D, Shamseer L, Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1
  • 15 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
  • 16 Lee SW, Chang JH, Ji JS. et al. Effect of Dynamic position changes on adenoma detection during colonoscope withdrawal: a randomized controlled multicenter trial. Am J Gastroenterol 2016; 111: 63-69
  • 17 Yamaguchi KMK, Nakagawa Y, Hayashi M. Dynamic position changes during the colonoscope withdrawal phase decrease abdominal fullness. Chiba Medical Journal 2013; 9-14
  • 18 Ghosh S, Iacucci M. Dynamic position change at colonoscopy improves adenoma detection. Can J Gastroenterol 2013; 27: 508
  • 19 Fletcher JG, Johnson CD, Welch TJ. et al. Optimization of CT colonography technique: prospective trial in 180 patients. Radiology 2000; 216: 704-711
  • 20 Facciorusso A, Triantafyllou K, Murad MH. et al. Compared abilities of endoscopic techniques to increase colon adenoma detection rates: a network meta-analysis. Clin Gastroenterol Hepatol 2019; 17: 2439-2454
  • 21 Facciorusso A, Del Prete V, Buccino RV. et al. Comparative efficacy of colonoscope distal attachment devices in increasing rates of adenoma detection: a network meta-analysis. Clin Gastroenterol Hepatol 2018; 16: 1209-1219 e1209