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Effect of Dynamic Position Changes on Adenoma Detection During Colonoscope Withdrawal: A Randomized Controlled Multicenter Trial

Lee, Seung-Woo MD, PhD1; Chang, Jae Hyuck MD, PhD2; Ji, Jeong-Seon MD, PhD3; Maeong, Il Ho MD2; Cheung, Dae Young MD, PhD4; Kim, Joon Sung MD3; Cho, Young-Seok MD, PhD5; Chung, Wook-Jin MD, PhD6; Lee, Bo-In MD, PhD5; Kim, Sang-Woo MD, PhD7; Kim, Byung-Wook MD, PhD3; Choi, Hwang MD, PhD3; Choi, Myung-Gyu MD, PhD5

American Journal of Gastroenterology: January 2016 - Volume 111 - Issue 1 - p 63–69
doi: 10.1038/ajg.2015.354
ORIGINAL CONTRIBUTIONS: ENDOSCOPY
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OBJECTIVES: Adequate luminal distension is essential for improving adenoma detection during colonoscope withdrawal. A few crossover studies have reported that dynamic position changes maximize luminal distension and increase adenoma detection rates (ADR). We designed a multicenter, randomized, parallel-group trial to verify the effect of dynamic position changes on colonic adenoma detection.

METHODS: This study was conducted at the six hospitals of the Catholic University of Korea. Patients aged 45–80 years who underwent a colonoscopy for the first time were included. In the position change group, the position changes during colonoscope withdrawal were as follows: cecum, ascending colon, and hepatic flexure: left lateral position; transverse colon: supine position; splenic flexure, descending colon, sigmoid colon, and rectum: right lateral position. In the control group, the examinations were performed entirely in the left lateral position during colonoscope withdrawal. The primary outcome measure was the ADR, which was defined as the proportion of patients with ≥1 adenoma.

RESULTS: A total of 1,072 patients were randomized into the position change group (536 patients) or the control group (536 patients). The ADR was higher in the position change group than in the control group (42.4 vs. 33.0%,P=0.002). More adenomas were detected per subject in the position change group (0.90 vs. 0.67,P=0.01). Increases in the number of adenomas were observed in examinations of the transverse colon (0.22 vs. 0.13,P=0.016) and the left colon (0.37 vs. 0.27,P=0.045). A significant increase in the ADR was observed for endoscopists with a relatively low detection rate. For endoscopists with a high detection rate, non-significant changes in the ADR were observed.

CONCLUSIONS: Dynamic position changes during colonoscope withdrawal increased the ADR.

1Department of Internal Medicine, Daejeon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea

2Department of Internal Medicine, Bucheon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea

3Division of Gastroenterology, Department of Internal Medicine, Incheon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea

4Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

5Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

6Department of Internal Medicine, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon, Republic of Korea

7Departments of Internal Medicine, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea

Correspondence: Jeong-Seon Ji, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Republic of Korea. E-mail: jjsdr@catholic.ac.kr

The study was presented as oral presentation at the United European Gastroenterology Week at Vienna, Austria in October 2014.

Guarantor of the article: Jeong-Seon Ji, MD, PhD.

Specific author contributions: Study concept, design, analysis of data, and drafting of the manuscript: Jeong-Seon Ji; acquisition of data: Seung-Woo Lee, Jae Hyuck Chang, Jeong-Seon Ji, Il Ho Maeong, Dae Young Cheung, and Joon Sung Kim; critical revision of the manuscript: Seung-Woo Lee, Young-Seok Cho, Wook-Jin Chung, Bo-In Lee, Sang-Woo Kim, Byung-Wook Kim, Hwang Choi, and Myung-Gyu Choi.

Financial support: Daewoong Pharmaceutical Scholarship 2011.

Potential competing interest: None.

© The American College of Gastroenterology 2016. All Rights Reserved.
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