Trendelenberg Versus Left Lateral Position for Colonoscopy

The Washington University

Status: Completed

Conditions: Colonic Diseases

Study type: Observational

Funder types: Other

Identifiers

NCT02519686

201504136

Details and patient eligibility

About

The purpose of this study is to determine if the trendelenberg (TD) position (position in procedures that involves placing the patient at an angle so that their head is lower than their feet on the procedure bed) in select patients undergoing colonoscopy is superior than the left lateral (LL) position (patient laying on their side, traditionally used for colonoscopies) in terms of decreasing time necessary to pass the colonoscope through the left colon, and decreasing the difficulty of the procedure.

Full description

The colonoscopists will be asked to rate their prediction of difficulty of the procedure prior to the colonoscopy and to rate the ease of procedure after the colonoscopy. The clinical experience of the study investigators is that TD positioning is superior to LL positioning in patients with risk factors for having a difficult colonoscopy (thin women; those with diverticulosis- small bulging pouches present in the colon; or prior pelvic surgery).

Patients with risk factors for difficult colonoscopy will be randomized to undergo colonoscopy while positioned in the TD position or the LL position during advancement of the colonoscope through the sigmoid colon. The sigmoid colon is a section of the colon, proximal to the rectum, that is curved. The sigmoid colon is a normal component of GI tract anatomy, although due to it's shape, especially with the risk factors listed previously; can cause challenges to inserting the colonoscope.

Enrollment: 150 patients

Sex: Female

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Personal history of pelvic surgery
2. Diverticulosis, identified by patient report or review of previous colonoscopy or imaging studies.
3. BMI < 25.

Exclusion criteria

1. Patients who do not meet inclusion criteria.
2. Patients who have undergone colonic resection
3. Patients with glaucoma
4. Patients with uncontrolled acid reflux disease or active nausea/vomiting.
5. Patients who are unwilling or unable to consent.
6. BMI > 30

Trial design

150 participants in 2 patient groups

Trendelenburg position maneuver

Description:

Trendelenburg (TD) positioning (supine with head tilt-down) is used in abdominal and gynecological surgery as well as during colonoscopy to allow better access to the pelvic organs, as gravity pulls the bowel out of the pelvic cavity and the rectosigmoid angle straightens.

Left lateral position maneuver

Description:

Left Lateral (LL) position (patient laying on their side, traditionally used for colonoscopies)