Illustration of a colonoscopy procedure showing a camera entering the colon from the right side, emphasizing patient comfort.

Gut Check: Can Your Starting Position During a Colonoscopy Really Make a Difference?

Mira Elwood in Health & Wellness November 2026 • 4 min read.

"New research suggests that the position you start in during a colonoscopy could impact procedure time and comfort. Here’s what you need to know to advocate for a smoother screening."

Colonoscopies: They're a vital screening tool, but let's be honest, not exactly a walk in the park. The procedure involves inserting a flexible tube with a camera into the colon to detect polyps or other abnormalities. While the process itself has become quite refined, a group of researchers wondered if a simple adjustment could improve the experience: the patient's starting position.

Traditionally, colonoscopies begin with the patient lying on their left side, known as the left lateral position (LLP). However, a new study presented at a major gastroenterology conference explored whether starting on the right side—the right lateral position (RLP)—could offer any advantages. Their findings might surprise you.

This article breaks down the key findings of this study, explaining how your starting position during a colonoscopy could impact procedure time, comfort levels, and overall experience. We'll explore the potential benefits of RLP and what this means for you as you prepare for your next screening.

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Standard Approach

How Colonoscopy Works

A colonoscopy examines the inside of the large intestine using a long, flexible tube called a colonoscope. The instrument is inserted through the rectum and guided through the colon, while a small camera sends images to a monitor so a health professional can examine the colon lining. The procedure can help diagnose gastrointestinal diseases, including inflammatory bowel disease and colon cancer, and the colon must be empty for the examination to be successful.

The Right Move? Exploring the Potential Benefits of RLP

Illustration of a colonoscopy procedure showing a camera entering the colon from the right side, emphasizing patient comfort.

The study, titled 'Results of the ROLCOL Study: A Randomised Controlled Trial of Right Versus Left Starting Position in Colonoscopy,' aimed to directly compare the two starting positions. Researchers recruited 167 patients scheduled for colonoscopies and randomly assigned them to begin in either the LLP or RLP. The study carefully considered factors like age, gender, BMI, and the endoscopist's experience level.

The primary goal was to measure the time it took to reach the cecum—the end of the colon. Secondary measures included patient comfort, assessed using a visual analogue scale (VAS), and the amount of intravenous sedation required during the procedure. Here’s what they discovered:

Faster Procedure Times: Patients who started in the RLP reached the cecum significantly faster than those in the LLP (498 seconds vs. 698 seconds, p < 0.01). That's a considerable time saving!
Improved Comfort: Patients reported greater comfort with the RLP compared to the LLP (VAS scores of 2 vs. 3, p = 0.02). Even a small improvement in comfort can make a big difference during a colonoscopy.
Specific Groups Benefited Most: Women and individuals with a history of abdominal surgery experienced the most significant benefits from starting in the RLP.
No Difference in Sedation: Interestingly, there was no significant difference in the amount of sedation needed between the two groups.

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Latest Research

Evidence Comparing Starting Positions

A review identified five randomized controlled trials involving 809 participants that compared left-lateral (LL) with right-lateral (RL) colonoscopy. The pooled odds ratio for cecal intubation rate was 1.3, with a 95% confidence interval of 0.8 to 2.3. The result was not statistically significant (P=0.3), so these trials did not establish a clear difference in cecal intubation rates between the two positions.

Counterpoints

Limits of the Evidence

The reported study noted that both patients and colonoscopists were unblinded. Its modified water immersion (m-WI) method used suction during insertion not only to evacuate fecal debris but also to help passage through difficult or angulated colonic flexures. These features can complicate interpretation of the method's effects because the intervention involved more than a single procedural maneuver.

The researchers concluded that starting position in colonoscopy is an independent factor affecting the time it takes to reach the cecum. In other words, RLP could be a simple and effective way to make colonoscopies faster and more comfortable for many patients.

Talking to Your Doctor: What Does This Mean for Your Next Colonoscopy?

While these findings are promising, it's important to remember that this is just one study. However, it does raise an interesting point: a simple change in procedure could potentially lead to a better patient experience. As you prepare for your next colonoscopy, consider discussing this research with your doctor. Ask if starting in the right lateral position might be a good option for you, especially if you are a woman or have had previous abdominal surgery. Together, you can make informed decisions about your health and well-being.

Starting-position comparisons in the reported figures

P=0.0078Another trial reported a quicker median time to reach the cecum with right-lateral rather than left-lateral starting position (P=0.0078).^[1]

How other comparisons frame starting position

For pain, the review noted that other factors, including water-infusion colonoscopy, were not ruled out; that leaves uncertainty about whether starting position alone accounts for reported pain differences.^[2]

A proposed explanation for right-lateral positioning is that air may preferentially fill the left colon, increasing distention and potentially aiding navigation. This is a proposed mechanism, not a result demonstrating that the mechanism caused a timing difference.^[3]

Position changes during withdrawal have also been described as a maneuver to enhance luminal distention as air or carbon dioxide rises to the highest position; this concerns withdrawal rather than the starting-position comparison.^[4]

What remains unresolved about starting position

Would the cecal insertion-time comparison change if bowel preparation and sex-specific results were evaluated? The review noted these factors were not evaluated in studies of supine and tilt-down starting positions.^[2]
How much of any pain difference is attributable to starting position rather than other procedural factors such as water infusion? Those factors were not ruled out in the review.^[2]

Sources

Right Or Left in COLonoscopy (ROLCOL)? A Randomized Controlled Trial of Right- versus Left-Sided Starting Position in Colonoscopy. (pubmed.ncbi.nlm.nih.gov)
Efficacy and safety of the starting position during colonoscopy: a systematic review and meta-analysis (pmc.ncbi.nlm.nih.gov)
Comparison of left versus right lateral starting position on colonoscopy: a systematic review and meta-analysis of randomized controlled trials (pmc.ncbi.nlm.nih.gov)
Effect of dynamic position changes on adenoma detection rate during colonoscope withdrawal: systematic review and meta-analysis (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

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Everything You Need To Know

1

What is the difference between the right lateral position (RLP) and the left lateral position (LLP) in a colonoscopy?

The right lateral position (RLP) involves starting a colonoscopy with the patient lying on their right side, while the left lateral position (LLP) starts with the patient on their left side. The study investigated the impact of these starting positions on procedure time, patient comfort, and sedation requirements during colonoscopies. It found that RLP led to faster procedure times and improved comfort compared to LLP.

2

What is the main advantage of starting in the right lateral position (RLP) during a colonoscopy?

The primary benefit of starting in the right lateral position (RLP) during a colonoscopy, as highlighted in the study, is the potential for faster procedure times. The study indicated that patients in the RLP reached the cecum significantly faster than those in the left lateral position (LLP). This is important because shorter procedure times can translate to less discomfort for the patient and potentially greater efficiency for the medical team.

3

How does starting in the right lateral position (RLP) impact patient comfort during a colonoscopy?

The study found that patients reported greater comfort when starting in the right lateral position (RLP) compared to the left lateral position (LLP). Comfort was assessed using a visual analogue scale (VAS). Even a small improvement in comfort levels can significantly enhance the patient experience during a colonoscopy, which is a procedure that many people find unpleasant. This is an important finding because it indicates that a simple change in the procedure could lead to a better patient experience.

4

Which patient groups benefited the most from the right lateral position (RLP) in the study?

Women and individuals with a history of abdominal surgery experienced the most significant benefits from starting in the right lateral position (RLP) during a colonoscopy. This suggests that certain patient groups may particularly benefit from this approach, highlighting the importance of considering individual patient factors when planning a colonoscopy. The study provides important considerations that can be brought up with a doctor.

5

How should I use this information when preparing for my next colonoscopy?

Based on the study's findings, it is recommended that you discuss the possibility of starting in the right lateral position (RLP) with your doctor before your next colonoscopy. This is particularly relevant if you are a woman or have a history of abdominal surgery, as these groups may experience the most significant benefits in terms of faster procedure times and improved comfort. Discussing this research enables you to make informed decisions about your health and well-being and to advocate for a more comfortable screening process. Inform your physician of the research and ask if it's a good option for you.