Predictors for difficult cecal insertion in colonoscopy: The impact of obesity indices

Abstract

AIMTo identify the factors influencing cecal insertion time (CIT) and to evaluate the effect of obesity indices on CIT.METHODSWe retrospectively reviewed the data for participants who received both colonoscopy and abdominal computed tomography (CT) from February 2008 to May 2008 as part of a comprehensive health screening program. Age, gender, obesity indices [body mass index (BMI), waist-to-hip circumference ratio (WHR), waist circumference (WC), visceral adipose tissue (VAT) volume and subcutaneous adipose tissue (SAT) volume on abdominal CT], history of prior abdominal surgery, constipation, experience of the colonoscopist, quality of bowel preparation, diverticulosis and time required to reach the cecum were analyzed. CIT was categorized as longer than 10 min (prolonged CIT) and shorter than or equal to 10 min, and then the factors that required a CIT longer than 10 min were examined.RESULTSA total of 1678 participants were enrolled. The mean age was 50.42 ± 9.931 years and 60.3% were men. The mean BMI, WHR, WC, VAT volume and SAT volume were 23.92 ± 2.964 kg/m2, 0.90 ± 0.076, 86.95 ± 8.030 cm, 905.29 ± 475.220 cm3 and 1707.72 ± 576.550 cm3, respectively. The number of patients who underwent abdominal surgery was 268 (16.0%). Colonoscopy was performed by an attending physician alone in 61.9% of cases and with the involvement of a fellow in 38.1% of cases. The median CIT was 7 min (range 2-56 min, IQR 5-10 min), and mean CIT was 8.58 ± 5.291 min. Being female, BMI, VAT volume and involvement of fellow were significantly associated with a prolonged CIT in univariable analysis. In multivariable analysis, being female (OR = 1.29, P = 0.047), lower BMI (< 23 kg/m2) (OR = 1.62, P = 0.004) or higher BMI (≥ 25 kg/m2) (OR = 1.80, P < 0.001), low VAT volume (< 500 cm3) (OR = 1.50, P = 0.013) and fellow involvement (OR = 1.73, P < 0.001) were significant predictors of prolonged CIT. In subgroup analyses for gender, lower BMI or higher BMI and fellow involvement were predictors for prolonged CIT in both genders. However, low VAT volume was associated with prolonged CIT in only women (OR = 1.54, P = 0.034).CONCLUSIONBeing female, having a lower or higher BMI than the normal range, a low VAT volume, and fellow involvement were predictors of a longer CIT.

The impact of visceral adipose tissue as best predictor for difficult colonoscopy and the clinical utility of a long small-caliber scope as rescue

“…Lower VAT (VAT < 75 cm 2 ) had impact on both the ease of colonoscopy and longer CIT. This result is consistent with former reports demonstrating that lower VAT was significantly associated with longer CIT [ 21 – 23 ], since higher VAT might provide resistance and help prevent looping. However, to our surprise, the multivariate analysis also demonstrated that higher VAT (150 cm 2 ≤ VAT) caused difficult colonoscopy and longer CIT.…”

“…Visceral fat may help prevent looping formation, as those with higher BMI may have more fat, so that the colonoscope could reach the cecum more easily [ 6 ]. However, only a few recent studies have assessed the effect of VAT on difficult colonoscopy [ 21 – 23 ]. In the present study, lower BMI (BMI < 21 kg/m 2 ) was related to longer CIT during univariate analysis, but its effect disappeared in multivariate analysis, when another obesity index (VAT) was considered simultaneously.…”

Colonoscopy using back brace support belt: A randomized, prospective trial

“…Patients were recruited from December 2017 to September 2018. Having a lower or higher body mass index (BMI) was reported to be indicative of longer cecal intubation time (CIT) . Eligible patients aged 20–80 years with BMI ≥25 kg/m 2 or <18.5 kg/m 2 and/or previous CIT ≥8 min were enrolled.…”

(Technically) Difficult colonoscope insertion – Tips and tricks

“…Incomplete colonoscopies should be avoided, since patients in this context present an important prevalence of lesions that escape examination . Most patients with a prior incomplete colonoscopy can be colonoscoped successfully, using a variety of scopes, colonoscopy methods and additional equipment …”

“…3 Most patients with a prior incomplete colonoscopy can be colonoscoped successfully, using a variety of scopes, colonoscopy methods and additional equipment. 1,[7][8][9] Difficult colonoscopy may be conditioned by patient factors and endoscopist/team related factors (Table 1). 1,[7][8][9] The normal colon has two areas of full fixation (ascending and descending colon), two of partial fixation (cecum and rectum), two ligamentous attachments (splenic flexure and hepatic flexure) and two areas with independent mesenteries (intraperitoneal segments: sigmoid and transverse colon).…”