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

Peiwen Li; Bin Ma; Shulei Gong; Xinyu Zhang; Wenya Li

doi:10.1007/s00464-020-07483-x

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

Surg Endosc. 2021 Mar;35(3):1171-1181. doi: 10.1007/s00464-020-07483-x. Epub 2020 Mar 3.

Authors

Peiwen Li¹, Bin Ma², Shulei Gong¹, Xinyu Zhang¹, Wenya Li³

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.
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.
³ Department of Thoracic Surgery, The First Hospital of China Medical University, No.155 North Nanjing Street, Shenyang, 110001, People's Republic of China. saint5288@hotmail.com.

PMID: 32128607
DOI: 10.1007/s00464-020-07483-x

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.

Keywords: Adenoma detection rate; Colonoscopy; Dynamic position changes; Polyp detection rate.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adenoma / diagnosis
Colon, Transverse / diagnostic imaging
Colon, Transverse / pathology
Colonic Polyps / diagnosis*
Colonoscopes
Colonoscopy / instrumentation
Colonoscopy / methods*
Colorectal Neoplasms / diagnosis*
Humans
Male
Middle Aged
Odds Ratio
Randomized Controlled Trials as Topic