A Comparison of Two Colonoscopic Withdrawal Techniques
Condition: Intestinal Polyps
MeSH terms: Polyps; Intestinal Polyps
Study type: Interventional
Phase: Phase 4

Summary: 
      This study will compare two strategies for colonoscope withdrawal, using polyp detection as
      the primary outcome measure, to determine the optimal withdrawal strategy.

      Null Hypothesis:

      On withdrawal of the colonoscope, examining patients with dynamic position change does not
      yield more polyps than the supine position.

      Alternative Hypothesis:

      On withdrawal of the colonoscope, examining the patients with dynamic position change
      improves polyp detection compared to the supine position.
    

Detailed description: 
      The identification and removal of polyps has been shown to prevent bowel cancer. Although
      colonoscopy is the best technique to identify polyps, polyps can be missed even in expert
      hands. Inspection of the bowel occurs predominantly during colonoscope withdrawal. Tailoring
      a patients position according to the segment of bowel being examined (dynamic position
      change) is a technique that has been shown to improve visualisation of the bowel wall and
      polyp detection. However, changing patient position during colonoscope withdrawal has not
      been widely accepted in clinical practice. This may be because of a lack of awareness of the
      literature, a perception that the benefit is negligible and the inconvenience of changing a
      patients position in addition to the small number of publications demonstrating this to be
      beneficial. We plan to compare the detection of polyps when colonoscope withdrawal is done
      with dynamic position change (a planned series of position changes to optimise mucosal
      visualisation) and the supine position (laid on back). These strategies will be compared by
      performing a double colonoscope withdrawal; The first withdrawal will be performed either
      supine or in the dynamic position. This will be followed by a second insertion and withdrawal
      in the alternative position. The order in which these strategies are performed will be
      randomised i.e. supine then dynamic or dynamic then supine.
    

Intervention name(s): Strategy : Supine first; Strategy : dynamic first
Intervention type(s): Procedure; Procedure
Intervention description(s): The initial withdrawal in each of 4 segments of the colon: 1)Caecum, Ascending colon and Hepatic flexure 2) Transverse colon 3) Splenic flexure and descending colon 4) Sigmoid colon, will be performed in two different positions. The intervention in this arm will be withdrawal in the supine position and then with dynamic position change.; The initial withdrawal in each of 4 segments of the colon: 1)Caecum, Ascending colon and Hepatic flexure 2) Transverse colon 3) Splenic flexure and descending colon 4) Sigmoid colon, will be performed in two different positions. The intervention in this arm will be withdrawal with dynamic position change first followed by the supine position.
Other intervention name(s): Dynamic position change; Supine position
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Polyp detection; Supine; Colonoscope withdrawal; Patient position; Dynamic position change