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Published bySophie Fox Modified over 8 years ago
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Dynamic patient position changes during colonoscope withdrawal increase adenoma detection : a randomized, crossover trial James E. East, MRCP, MD, Paul Bassett, MSc, Naila Arebi, PhD, MRCP, Siwan Thomas-Gibson, MD, MRCP, Thomas Guenther, MD, PhD, Brian P. Saunders, MD, FRCP Gastrointest Endosc 2011;73:456-63 2011.3.21 Hyun Hee Jae
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Introduction Lower adenoma miss rates Good colonoscopic withdrawal technique Longer withdrawal times Taking >6minutes Use of antispasmodics Optimal equipment Patients of operators with a low (<20%) adenoma detection rate Increased risk of interval cancer => Comprehensive adenoma detection may be important
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Position changes during the withdrawal Adequate distension of the colon & Movement of excess fluid away Gas to rise : fill the air Fluid to fall away to dependant areas Hepatic flexure RUQ -> left lateral position Transverse colon Relatively anteriorly in the abdomen -> supine position Splenic flexure & descending colon LUQ -> right lateral position
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Position changes during the withdrawal Recommend in some standard texts Rare in routine clinical practice Previous study Dynamic position change during colonoscope withdrawal on luminal distension The clinically important outcome measure of polyp and adenoma detection were not measured
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Methods Patients Aged 50 to 80 years Intact colons Routine colonoscopy Between November 2005 and August 2007 Colonoscopy By single experienced operator Examined in 3 segments Cecum, ascending colon, hepatic flexure Transverse colon Splenic flexure, descending colon
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Methods Examination either entirely in the left lateral position followed by position changes or vice versa Polyp size in mm, polyp shape, colon area Distension score (1 to 5) 1: total collase 5: widely distended
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Methods Primary outcome measure Proportion of patients with >1 adenoma detected in the segments Secondary outcome measures Number of patients with >1 polyp or adenoma detected in each colon segment Median adenoma and polyp size detected Number of patients who had a polyp or adenoma detected related to the distension
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Table 2. Patients with > 1 adenoma detected by colon segment
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Table 3. Patients with > 1 polyp detected by colon segment
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Table 4. Comparison of adenoma and polyp detection related to distension score
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Conclusion Dynamic position changes during colonoscope withdrawal significantly improved polyp and adenoma detection
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