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Abstract

We thank Ball et al for their insightful comments regarding our study1Ou G. Kim E. Lakzadeh P. et al.A randomized controlled trial assessing the effect of prescribed patient position changes during colonoscope withdrawal on adenoma detection.Gastrointest Endosc. 2014; 80: 277-283Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar and for the opportunity to expand on a few points. Our study demonstrated that prescribed position changes during colonoscope withdrawal do not improve adenoma detection rate compared with “usual care,” which included patient position changes at the endoscopists' discretion. Indeed, 33% of the colonoscopies in the control group involved at least 1 position change during colonoscope withdrawal to facilitate mucosal examination. Nearly all of the control patients were in the left lateral or supine position for examination of the cecum and the ascending and transverse colon. Interestingly, none of the control group patients changed into the right lateral position during examination of the descending and sigmoid colon. The 8 control patients examined in this manner were in the right lateral position upon intubation of the cecum and remained in this position for withdrawal. This practice pattern is different from that reported for English endoscopists.2Ball A.J. Johal S.S. Riley S.A. A comparison of two colonoscope withdrawal techniques: interim analysis of a randomised cross over study.Gut. 2013; 62: A49Crossref Google Scholar Previous studies have demonstrated improved luminal distension and adenoma detection with position change, from left lateral to supine in the transverse colon and from supine to right lateral in the left side of the colon.3East J.E. Suzuki N. Arebi N. et al.Position changes improve visibility during colonoscope withdrawal: a randomized, blinded, crossover trial.Gastrointest Endosc. 2007; 65: 263-269Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar, 4East J.E. Bassett P. Arebi N. et al.Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial.Gastrointest Endosc. 2011; 73: 456-463Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar However, adenoma detection is also dependent on numerous other factors, such as bowel preparation, withdrawal time, irrigation/suction, and examination of proximal folds. Therefore, although our results show that changing position in response to poor visibility is as effective as prescribed position change, we emphasize that this is contingent on a baseline high-quality colonoscope withdrawal technique. We agree that changing patient position during colonoscope withdrawal is a valuable maneuver when luminal distension is limited, when fluid repeatedly accumulates in the segment under examination, or when proximal folds cannot be adequately examined with torque and tip deflection alone. However, our findings do not support a practice change to prescribed positions during colonoscope withdrawal. Position change during colonoscope withdrawal: Is it worth the effort?Gastrointestinal EndoscopyVol. 80Issue 5PreviewWe read with interest the study by Ou et al1 assessing the influence of position change on adenoma detection during colonoscope withdrawal. We were initially surprised by the negative outcome of the study given, but we believe that may be largely explained by the study design. Full-Text PDF