Colonoscopy in the Prone Position for Patients With BMI Greater Than 30

NCT ID: NCT03337217

Last Updated: 2019-06-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

141 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-12-10

Study Completion Date

2019-06-10

Brief Summary

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In the United States, colonoscopy has become the most commonly used screening test for colorectal cancer. Colonoscopy is typically performed with the patient starting in the left lateral decubitus position, however there is little data to support this practice and starting position is variable amongst individual gastroenterology physicians.

The investigators plan to randomize patients with Body Mass Index \>30 that are presenting to the University of Virginia for colonoscopy to either the prone or left lateral decubitus position. The investigators will then record and compare cecal intubation times as well as amount of sedation used and complications to help determine which position is superior for this patient population.

Detailed Description

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Patients that have been scheduled for colonoscopy will undergo chart review. Patients who meet inclusion criteria will be invited to participate at the time consent is obtained for the colonoscopy. Participants will then be randomized to one of two colonoscopy starting positions.

After randomization, patients will begin the colonoscopy in either the prone position or left lateral decubitus position.

It is common practice to re-position the patient during endoscopy (including supine and prone positions) and some endoscopists commonly employ prone starting position for obese patients, although there is no estimate in the literature as to the prevalence of this practice.

No additional interventions will be performed for research purposes. During the colonoscopy, the endoscopist will be allowed, as usual, to adjust patient position as needed to complete the procedure. Cecal intubation time, amount of sedation used, and any intra-procedural complications (hypoxia, hypotension, etc) will be recorded for data analysis. This information is standardly recorded in the procedure report in the patient's medical record. The study will not affect any interventions performed during the colonoscopy such as polyp removal or biopsies as, clinically indicated. Per endoscopy unit protocol, patients will be monitored in the recovery area and discharged home with supervision. The study requires no further direct patient interaction after the colonoscopy is completed. Charts will be reviewed at 30 days to assess for any delayed and unexpected complications.

Conditions

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Obesity

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Prone Position

Position during colonoscopy

Group Type EXPERIMENTAL

Position during colonoscopy

Intervention Type PROCEDURE

Position during colonoscopy

Left lateral decubitus position

Position during colonoscopy

Group Type ACTIVE_COMPARATOR

Position during colonoscopy

Intervention Type PROCEDURE

Position during colonoscopy

Interventions

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Position during colonoscopy

Position during colonoscopy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* BMI \>30
* Undergoing screening or diagnostic colonoscopy with conscious sedation

Exclusion Criteria

* Pregnant women (self reported).
* Cognitively impaired patients
* History of colonic resection
* Cannot lay in prone position
* History of colon malignancy
* Procedure aborted due to inadequate bowel prep
* Severe pulmonary problems (including baseline oxygen use)
* Inability to provide consent for themselves
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Virginia

OTHER

Sponsor Role lead

Responsible Party

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Brooke Corning

Principal Investigator, Fellow Physician, Dept of Internal Medicine Division of Gastroenterology and Hepatology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Brooke Corning, MD

Role: PRINCIPAL_INVESTIGATOR

University of Virginia, Dept of Internal Medicine, Divison of Gastroenterology and Hepatology

Locations

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University of Virginia

Charlottesville, Virginia, United States

Site Status

Countries

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United States

References

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Uddin FS, Iqbal R, Harford WV, Dunbar KB, Cryer BL, Spechler SJ, Feagins LA. Prone positioning of obese patients for colonoscopy results in shortened cecal intubation times: a randomized trial. Dig Dis Sci. 2013 Mar;58(3):782-7. doi: 10.1007/s10620-012-2468-x. Epub 2012 Nov 10.

Reference Type BACKGROUND
PMID: 23143737 (View on PubMed)

Weinstock LB, Early DS. Colonoscopy in the tilt-down position. Gastrointest Endosc. 2014 Oct;80(4):746. doi: 10.1016/j.gie.2014.05.328. No abstract available.

Reference Type BACKGROUND
PMID: 25220519 (View on PubMed)

Rex DK. Achieving cecal intubation in the very difficult colon. Gastrointest Endosc. 2008 May;67(6):938-44. doi: 10.1016/j.gie.2007.12.028. No abstract available.

Reference Type BACKGROUND
PMID: 18440383 (View on PubMed)

De Silva AP, Kumarasena RS, Perera Keragala SD, Kalubowila U, Niriella M, Dassanayake AS, Pathmeswaran A, de Silva HJ. The prone 12 o'clock position reduces ileal intubation time during colonoscopy compared to the left lateral 6 o'clock (standard) position. BMC Gastroenterol. 2011 Aug 4;11:89. doi: 10.1186/1471-230X-11-89.

Reference Type BACKGROUND
PMID: 21816067 (View on PubMed)

Vergis N, McGrath AK, Stoddart CH, Hoare JM. Right Or Left in COLonoscopy (ROLCOL)? A Randomized Controlled Trial of Right- versus Left-Sided Starting Position in Colonoscopy. Am J Gastroenterol. 2015 Nov;110(11):1576-81. doi: 10.1038/ajg.2015.298. Epub 2015 Sep 29.

Reference Type BACKGROUND
PMID: 26416195 (View on PubMed)

Lucendo AJ. Colonoscopy in obese patients: time to change position. Dig Dis Sci. 2013 Mar;58(3):608-9. doi: 10.1007/s10620-012-2542-4. Epub 2013 Jan 12. No abstract available.

Reference Type BACKGROUND
PMID: 23314857 (View on PubMed)

Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012 Sep;143(3):844-857. doi: 10.1053/j.gastro.2012.06.001. Epub 2012 Jul 3. No abstract available.

Reference Type BACKGROUND
PMID: 22763141 (View on PubMed)

Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA. 2016 Jun 7;315(21):2284-91. doi: 10.1001/jama.2016.6458.

Reference Type BACKGROUND
PMID: 27272580 (View on PubMed)

Witte TN, Enns R. The difficult colonoscopy. Can J Gastroenterol. 2007 Aug;21(8):487-90. doi: 10.1155/2007/520431. No abstract available.

Reference Type BACKGROUND
PMID: 17703247 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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20078

Identifier Type: -

Identifier Source: org_study_id

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