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Effect of left lateral tilt-down position on cecal intubation time: a 2-center, pragmatic, randomized controlled trial.

Abstract：

BACKGROUND AND AIMS:Colonoscopy insertion is technically challenging, time-consuming, and painful, especially for the sigmoid. Several pilot studies indicated that the (left) tilt-down position could facilitate the insertion procedure, but no formal trials have been published to demonstrate its efficacy. We performed this study to verify the benefits of the left lateral tilt-down position (LTDP) on the insertion process. METHODS:This 2-center prospective trial randomized unsedated patients to the LTDP or left lateral horizontal position (LHP) to aid insertion. The primary outcome measure was cecal intubation time (CIT). Secondary outcome measures included decending colon intubation time (DIT), pain score of insertion, acceptance of unsedated colonoscopy for future examinations, difficulty score for insertion, and the adverse event rate of colonoscopy. RESULTS:Two hundred fifty-eight patients were randomized to the LTDP (128) or LHP (130) in 2 centers. The median CIT and DIT were shorter with patients positioned in LTDP than in LHP (CIT, 280.0 vs 339.5 s, P < .001; DIT, 53.0 vs 69.0 s, P < .001, respectively) and patients with high and low body mass index (BMI) benefited more from LTDP than from LHP, as opposed to patients with normal BMI. In addition, colonoscopy insertion in LTDP was less painful (3.4 ± 1.6 vs 4.0 ± 1.7, P = .02) and less difficult (3.1 ± 1.9 vs 3.7 ± 1.4, P < .001), showing a higher tendency to acceptance of unsedated colonoscopy (82.9% vs 73.8%, P = .08). The rates of adverse events were extremely low and did not differ significantly in the 2 groups. CONCLUSIONS:LTDP for colonoscopy insertion can reduce insertion time and pain, and potentially improves patients' acceptance of unsedated colonoscopy. (Clinical trial registration number: NCT02842489.).

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Zhao SB,Yang X,Fang J,Wang SL,Gu L,Xia T,Su XJ,Wang D,Li ZS,Bai Y

doi

10.1016/j.gie.2017.11.012

subject

Has Abstract

pub_date

2018-03-01 00:00:00

pages

852-861

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(17)32472-0

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Effect of left lateral tilt-down position on cecal intubation time: a 2-center, pragmatic, randomized controlled trial.