The Prone 12 o'clock position reduces iIleal intubation time during colonoscopy compared to the left lateral 6 o'clock (standard) position

Abstract

INTRODUCTION Ileal intubation is the gold standard for evidence of a complete colonoscopy. However, despite evidence of clinical benefit, ileoscopy is not always attempted due to perceived technical difficulty. Although several studies have previously reported on the time taken for ileal intubation, such timings have not been standardized. Aim To compare time taken for ileal intubation using a new position - the prone 12 o’clock position (PP) - with the standard method (left lateral 6 o’clock position-LLP). METHODS We first performed a pilot study using fluoroscopy to determine the best patient position for the most direct (end-on) approach to the ileo-caecal valve. The prone 12 o’clock position appeared to be the best position. We then randomized consecutive patients having colonoscopy, aged 18-80 years and who were not pregnant, to undergo ileoscopy in the standard position or the prone 12 o’clock position. After the ileo-caecal valve was identified during colonoscopy, ileal intubation time was standardized and defined as the time taken for the tip of the colonoscope to be maneuvered from the mid-point of the caecum to entering the terminal ileum. RESULTS Colonoscopy was performed on 150 patients [82 females, mean (SD) age 53 (16) years]. 75 patients were randomized for ileal intubation in the PP and 75 patients in the LLP. Overall, the ileum was successfully intubated in 145 (96%) patients [74 (98.7%) in the PP and71 (94.7%) in the LLP]. The mean (SD) ileal intubation time was 26.4 (63) seconds in the PP and 96.9 (112) seconds in the LLP (p0.0001; Student t-test). The ileum was abnormal in 11 (7.5%) patients: 6 in the PP group and 5 in the LLP group. CONCLUSIONS During colonoscopy, the prone 12 o’clock position gives a more direct approach to the ileo-caecal valve and significantly reduces ileal intubation time when compared to the standard left lateral 6 o’clock position