Study

ROLCOL – Right or Left-sided starting position in colonoscopy

110405-N-KA543-028 SAN DIEGO (April 5, 2011) Hospitalman Urian D. Thompson, left, Lt. Cmdr. Eric A. Lavery and Registered Nurse Steven Cherry review the monitor while Lavery uses a colonoscope on a patient during a colonoscopy at Naval Medical Center San Diego. (U.S. Navy photo by Mass Communication Specialist 2nd Class Chad A. Bascom/Released) I don’t know about you, but during my fellowship thus far, I’ve only done one or two cases where the patient was positioned on the right side. Both were ICU/CCU cases, and both times we’ve reached the cecum without an issue. Positioning in those cases was difficult secondary to all the cardiac/ICU hardware the patient was hooked up to.

This study, which is amazing to see, since it actually examines a commonly held practice, something arose more from tradition/long held beliefs, rather than evidence.  There aren’t that many studies that actually go and do that.

The authors have found that right-sided positioning at the start of the colonoscopy results in a better, quicker, more comfortable procedure. N was about 80 for both arms, and about 75 cases were analyzed in post. Primary outcome was time to reach cecum.

Conclusion – 3 min and 33 seconds (30%) shorter if starter on the right side. Benefit stems largely from improved negotiation of the sigmoid.

Of note, there is a figure in the text, Figure 5, which shows how terrible fellows like me are at doing endoscopy in terms of time to cecal intubation.  Also, shows that the dramatic reduction in time to cecum happens not after 500 colonoscopies, but after 5000 colonoscopies!

We need more of these kinds of studies. The types that test “tried and true” practices, simple design, simple conclusions.

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