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Effect of dynamic position changes during colonoscope withdrawal: a meta-analysis of randomized controlled trials

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Abstract

Background

Colonoscopies are considered to be the primary screening test and gold standard test for colorectal cancer. Position changes during colonoscope withdrawal are believed to be associated with an increased adenoma detection rate (ADR) and polyp detection rate (PDR). However, previous results conflicted, and this study aimed to elucidate the effectiveness of dynamic position changes during colonoscope withdrawal.

Methods

The relevant publications were identified by searching the medical databases. The primary outcomes were the ADR and PDR, which were pooled and analyzed. The secondary outcome was the withdrawal time. The studies that supplied the ADR and PDR for different segments of the colon were separated into subgroup analyses.

Results

Five randomized controlled trials were eligible for analysis. The total ADR was higher with dynamic position changes than with a static position (odds ratio, [OR] 1.34; 95% confidence interval [CI] 1.13–1.59; p < 0.001), with low evidence of between-study heterogeneity (I2 = 0%). Although the total PDR was slightly higher with dynamic position changes than with a static position (OR 1.23; 95% CI 0.88–1.73), there difference was not statistically significant (p = 0.22). The withdrawal time was only increased by 0.47 min (95% CI − 0.11 to 1.06) with dynamic position changes, without statistical significance (p = 0.11). The subgroup analysis showed that the ADR and PDR for the transverse colon were higher with dynamic position changes, with pooled estimates of ADR (OR 1.72; 95% CI 1.02–2.88; p = 0.04) and PDR (OR 1.79; 95% CI 1.08–2.96; p = 0.02).

Conclusion

Dynamic position changes during colonoscope withdrawal increased the total ADR; however, no obvious increase was found in the total PDR. The withdrawal time was not significantly prolonged with dynamic position changes. Subgroup analysis showed that the ADR and PDR in the transverse colon were obviously improved with dynamic position changes.

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Acknowledgements

Special thanks to Dr. Bin Ma for his selfless teaching and help for Dr. Peiwen Li to conduct this study.

Funding

This study was supported by the Natural Science Foundation of Liaoning Province (Grant No. 2015020561), the Fund for Scientific Research of The First Hospital of China Medical University (Grant No. fsfh1514) and Wu Jieping Medical Foundation (Grant No. 320.6750.18293).

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Authors and Affiliations

  1. Department of Thoracic Surgery, The First Hospital of China Medical University, No.155 North Nanjing Street, Shenyang, 110001, People’s Republic of China

    Peiwen Li, Shulei Gong, Xinyu Zhang & Wenya Li

  2. Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People’s Republic of China

    Bin Ma

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  1. Peiwen Li
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  2. Bin Ma
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  5. Wenya Li
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Corresponding author

Correspondence to Wenya Li.

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Disclosure

Dr. Peiwen Li, Dr. Bin Ma, Dr. Shulei Gong, Dr. Xinyu Zhang, and Dr. Wenya Li have no conflicts of interest or financial ties to disclose.

Ethical approval

This meta-analysis was not related to any patient privacy or related information, so there was no need for IRB approval.

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Li, P., Ma, B., Gong, S. et al. Effect of dynamic position changes during colonoscope withdrawal: a meta-analysis of randomized controlled trials. Surg Endosc 35, 1171–1181 (2021). https://doi.org/10.1007/s00464-020-07483-x

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  • DOI: https://doi.org/10.1007/s00464-020-07483-x

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