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Starting position during colonoscopy: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Background

Traditional teaching has been to place patients in the left lateral decubitus starting position for colonoscopies. Recent randomized controlled trials (RCTs) have compared left lateral decubitus starting position to other approaches. The aim of this systematic review and meta-analysis was to compare different starting positions for colonoscopies and their effect on cecal intubation.

Methods

MEDLINE, Embase, and CENTRAL were searched from inception to July 2023. Articles were eligible for inclusion if they were RCTs comparing at least two different starting positions for adults undergoing colonoscopy. The main outcome was cecal intubation time. Meta-analysis used an inverse variance random effects model. Risk of bias was assessed with the Cochrane Tool for RCTs 2.0.

Results

After screening 1523 citations, 14 RCTs were included. Four studies compared left lateral decubitus to right lateral decubitus, four studies compared left lateral decubitus to left lateral tilt-down, three studies compared left lateral decubitus to prone, and three studies compared left lateral decubitus to supine. There were no statistically significant differences in cecal intubation time in seconds across all comparisons: left lateral decubitus vs. right lateral decubitus (MD 14.9, 95% CI − 111.8 to 141.6, p = 0.82, I2 = 85%); left lateral decubitus vs. left lateral tilt-down (MD − 31.3, 95% CI − 70.8 to 8.3, p = 0.12, I2 = 82%); left lateral decubitus vs. prone (MD 17.2, 95% CI − 174.9 to 209.4, p = 0.86, I2 = 94%); left lateral decubitus vs. supine (MD − 149.9, 95% CI − 443.6 to 143.9, p = 0.32, I2 = 89%).

Conclusion

The starting position for colonoscopies likely does not influence cecal intubation time. This study was limited by heterogeneity.

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Funding

This research was conducted without external or internal sources of funding.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, McMaster University, St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    T. McKechnie, Y. Lee, N. Sne, D. Hong & C. Eskicioglu

  2. Liberty University, Lynchburg, VA, USA

    L. Heimann

  3. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    T. Kazi, G. Jessani, N. Sne, D. Hong & C. Eskicioglu

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  1. T. McKechnie
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Contributions

Conception and design of the study—all authors. Acquisition of data—TM, LH, TK, GJ. Analysis and interpretation of data—all authors. Drafting and revision of the manuscript—all authors. Approval of the final version of the manuscript—all authors. Agreement to be accountable for all aspects of the work—all authors.

Corresponding author

Correspondence to C. Eskicioglu.

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The authors declare no competing interests.

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CRD42022379834.

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This study did not require ethical approval or attainment of informed consent as no primary data collection occured.

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McKechnie, T., Heimann, L., Kazi, T. et al. Starting position during colonoscopy: a systematic review and meta-analysis of randomized controlled trials. Tech Coloproctol 28, 39 (2024). https://doi.org/10.1007/s10151-024-02912-8

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