Abdominal Pressure and Patient Position Changes During Colonoscopy: Potential Adjunct Variables in Assessment of Colonoscopy Competence

Purpose: Colonoscopy competency is a critical milestone in progression through gastroenterology fellowship. Overcoming looping is essential for achieving proficiency – often overcome with abdominal pressure and patient position changes. Literature is limited on the systematic evaluation of these maneuvers in training centers. We aim to evaluate the frequency of abdominal pressure and/or patient position adjustments throughout fellowship. Methods: This was a cross-sectional study of 1029 individuals undergoing colonoscopy at the Oklahoma City VA Medical Center. Maneuvers used were assessed using a questionnaire completed by the endoscopist. Patient demographics were extracted retrospectively. Factors associated with need for abdominal pressure or position changes were determined through univariate and multivariate regression analyses. Adjusted odds ratios (aOR) were calculated using attending physicians as the reference and comparing them to junior (first year) and senior fellows (second/third year). Results: 999/1029 (97%) of colonoscopies had post-procedure questionnaires completed. Female sex (OR=1.6, 95% CI: 1.1, 2.4), moderate sedation (OR=1.5, 95% CI: 1.1, 2.1), and fellow involvement (OR=2.3, 95% CI: 1.7, 3.1) were significantly associated with abdominal pressure or patient position changes. Either or both maneuvers were required in 193 (51%) junior fellow cases (aOR=1.6, 95% CI: 1.3, 1.9); 128 (42%) senior fellow cases (aOR=2.0, 95% CI: 1.4, 2.9); and 82 (26%) attending-only cases (aOR=1.00). Conclusions: Abdominal pressure and patient repositioning were more common in fellow-led colonoscopies but decreased with training progression. This study emphasizes the potential utility of incorporating these maneuvers into colonoscopy competency assessment tools to help provide standardization of loop management across fellowship programs.