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...

Full description

Saved in:
Bibliographic Details
Published in:Techniques in coloproctology 2024-12, Vol.28 (1), p.39, Article 39
Main Authors: McKechnie, T., Heimann, L., Kazi, T., Jessani, G., Lee, Y., Sne, N., Hong, D., Eskicioglu, C.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Adults
Bias
Cecum
Clinical outcomes
Clinical trials
Colonoscopy
Colorectal Surgery
Endoscopy
Gastroenterology
Humans
Intervention
Intubation
Medicine
Medicine & Public Health
Original Article
Patient Positioning
Proctology
Randomized Controlled Trials as Topic
Surgery
Systematic review
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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, I 2  = 85%); left lateral decubitus vs. left lateral tilt-down (MD − 31.3, 95% CI − 70.8 to 8.3, p  = 0.12, I 2  = 82%); left lateral decubitus vs. prone (MD 17.2, 95% CI − 174.9 to 209.4, p  = 0.86, I 2  = 94%); left lateral decubitus vs. supine (MD − 149.9, 95% CI − 443.6 to 143.9, p  = 0.32, I 2  = 89%). Conclusion The starting position for colonoscopies likely does not influence cecal intubation time. This study was limited by heterogeneity.
ISSN:1123-6337
1128-045X
1128-045X
DOI:10.1007/s10151-024-02912-8