Colonoscopy is the gold standard for colorectal cancer prevention, yet small, flat, and sessile serrated polyps are frequently missed. Patient positioning affects colonic distension and mucosal visualization. This study evaluated whether systematic changes in patient position—including left lateral, right lateral, ventral, and dorsal decubitus—improve polyp detection

We conducted a prospective study of 56 consecutive patients undergoing screening or surveillance colonoscopy with adequate bowel preparation (Boston score ≥6) between January 2025 and September 2025. Initial inspection was performed in the left lateral decubitus position. During evaluation of the transverse and right colon, positions were systematically changed to optimize mucosal exposure. All detected polyps were resected and analyzed histologically. The number of polyps detected before and after position change, their size, morphology, location, and histology were recorded.

The cohort had a mean age of 60 years, 54% men, and mean Boston score 7.4. Initial left lateral inspection detected 72 polyps. Systematic position changes yielded 18 additional polyps (20% of total), predominantly small (<5 mm), flat (Paris IIa), and located mainly in the right colon (55%) and transverse colon (30%). Histology revealed adenomas (50%), sessile serrated lesions (33%), and hyperplastic polyps (17%). No adverse events occurred, and procedure time was not significantly prolonged.

Systematic patient position changes during colonoscopy significantly increase polyp detection, particularly small, flat, and sessile serrated lesions in the right and transverse colon. This safe, simple, and cost-effective strategy can enhance colonoscopy quality and colorectal cancer prevention. Multicenter studies are warranted to validate these findings and inform training and procedural recommendations.