Impact of Tilt-Down Positioning Compared With Left Lateral Positioning on Ease of Colonoscope Insertion During Colonoscopy.
Journal
Journal of clinical gastroenterology
ISSN: 1539-2031
Titre abrégé: J Clin Gastroenterol
Pays: United States
ID NLM: 7910017
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
pubmed:
6
2
2020
medline:
25
6
2021
entrez:
4
2
2020
Statut:
ppublish
Résumé
The aim of this study was to evaluate the efficacy of tilt-down (TD) versus left lateral (LL) positioning in speed and ease of colonoscope insertion in women with risk factors for difficult colonoscopy. Risk factors for difficult colonoscopy in women include pelvic surgery, diverticulosis, and thin body habitus. Female patients with body mass index (BMI) under 25, diverticulosis and history of pelvic surgery were randomized to TD or LL positioning. Five colonoscopists performed all studies at a single center. Time to splenic flexure and cecum, type and amount of medication administered, Boston Bowel Prep Score (BBPS), adverse events, and findings were recorded. The Mann-Whitney U test was used to evaluate the primary endpoint. A total of 150 women were enrolled (81 TD, 69 LL). The mean age was 60.1 (SD 10.5) and the mean BMI was 23.9 (SD 3.5). In total 98 (65.3%) women had prior pelvic surgery, 94 (62.7%) had BMI <25 and 60 (40.0%) had diverticulosis. There was no statistically significant difference in time to the splenic flexure overall but insertion to the splenic flexure was significantly faster in the TD position as compared with the LL position in patients with diverticulosis (124 s for TD, 160 s for LL, P=0.022). In a linear regression analysis, lower BMI, diverticulosis and lower BBPS were significantly associated with a longer insertion time to the splenic flexure. There were no adverse events. TD positioning represents a straightforward maneuver to facilitate advancement through the sigmoid colon and may be beneficial in women with diverticular disease.
Sections du résumé
GOALS
The aim of this study was to evaluate the efficacy of tilt-down (TD) versus left lateral (LL) positioning in speed and ease of colonoscope insertion in women with risk factors for difficult colonoscopy.
BACKGROUND
Risk factors for difficult colonoscopy in women include pelvic surgery, diverticulosis, and thin body habitus.
STUDY
Female patients with body mass index (BMI) under 25, diverticulosis and history of pelvic surgery were randomized to TD or LL positioning. Five colonoscopists performed all studies at a single center. Time to splenic flexure and cecum, type and amount of medication administered, Boston Bowel Prep Score (BBPS), adverse events, and findings were recorded. The Mann-Whitney U test was used to evaluate the primary endpoint.
RESULTS
A total of 150 women were enrolled (81 TD, 69 LL). The mean age was 60.1 (SD 10.5) and the mean BMI was 23.9 (SD 3.5). In total 98 (65.3%) women had prior pelvic surgery, 94 (62.7%) had BMI <25 and 60 (40.0%) had diverticulosis. There was no statistically significant difference in time to the splenic flexure overall but insertion to the splenic flexure was significantly faster in the TD position as compared with the LL position in patients with diverticulosis (124 s for TD, 160 s for LL, P=0.022). In a linear regression analysis, lower BMI, diverticulosis and lower BBPS were significantly associated with a longer insertion time to the splenic flexure. There were no adverse events.
CONCLUSION
TD positioning represents a straightforward maneuver to facilitate advancement through the sigmoid colon and may be beneficial in women with diverticular disease.
Identifiants
pubmed: 32011402
doi: 10.1097/MCG.0000000000001318
pii: 00004836-202007000-00014
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
558-560Commentaires et corrections
Type : CommentIn
Références
Rex D, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739–750.
Early D, Ben-Menachem T, Decker G, et al. Appropriate use of GI endoscopy. Gastrointest Endosc. 2012;75:1127–1131.
Bernstein C, Thorn M, Monsees K, et al. A prospective study of factors that determine cecal intubation time at colonoscopy. Gastrointest Endosc. 2005;61:72–75.
Anderson J, Messina C, Cohn W, et al. Factors predictive of difficult colonoscopy. Gastrointest Endosc. 2001;54:558–562.
Clancy C, Burke J, Chang K, et al. The effect of hysterectomy on colonoscopy completion: a systematic review and meta-analysis. Dis Colon Rectum. 2014;57:1317–1323.
Saad A, Winn J, Chennaman V, et al. The value of the Trendelenburg position during routine colonoscopy: a pilot study. Gastroenterology. 2012;142:S-229.
Weinstock LB, Early DS, Saad AM. Tilt down method for colonoscopy: novel safe and effective scope insertion technique [Abstract]. Am J Gastroenterol. 2013;108:S573.
Weinstock L, Early D. Colonoscopy in the tilt-down position. Gastrointest Endosc. 2014;80:746.
Thorlakson RH, Thorlakson TK. The lithotomy-Trendelenburg position for restorative resection by stapling and abdominoperineal excision of the rectum. Can J Surg. 1984;27:246–247.
Wen T, Deibert C, Siringo F, et al. Positioning-related complications of minimally invasive radical prostatectomies. J Endourol. 2014;28:660–667.
Mallick S, Das A, Dutta S, et al. A prospective, double-blind randomized controlled study comparing two different Trendelenburg tilts in laparoscopically assisted vaginal hysterectomy positioning. J Nat Sci Biol Med. 2015;6:153–158.
Rex DK, Chen SC, Overhiser AJ. Colonoscopy technique in consecutive patients referred for prior incomplete colonoscopy. Clin Gastroenterol Hepatol. 2007;5:879–883.
Kaltenbach T, Soetikno R, Friedland S. Use of a double balloon enteroscope facilitates caecal intubation after incomplete colonoscopy with a standard colonoscope. Dig Liver Dis. 2006;38:921–925.
Ozcan MS, Praetel C, Bhatti MT, et al. The effect of body inclination during prone positioning on intraocular pressure in awake volunteers: a comparison of two operating tables. Anesth Analg. 2004;99:1152–1158.
Meininger D, Zwissler B, Byhahn C, et al. Impact of overweight and pneumoperitoneum on hemodynamics and oxygenation during prolonged laparoscopic surgery. World J Surg. 2006;30:520–526.