Why is colonoscopy more difficult in women?

Saunders, Brian P.; Fukumoto, Masashi; Halligan, Steve; Jobling, C.; Moussa, Mohammed E.; Bartram, Clive I.; Williams, Christopher

doi:10.1016/s0016-5107(06)80113-6

Cited by 241 publications

(180 citation statements)

References 4 publications

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“…A statistical study showed similar risk for males and females [8]. One study showed a greater total colonic length in females, suggesting this as the cause for more difficult procedures [18].…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic perforations: a review of 30,366 patients

et al. 2007

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Background: Although the incidence of perforation after endoscopic procedures of the colon is low, the rising number of procedures could pose relevant health problems. Recognizing risk factors and optimizing treatment may reduce perforation incidence and the probability of (severe) complications. This study aimed to determine perforation frequency and the management of endoscopic colonoscopic perforation. Methods: A retrospective review of patient records was performed for all patients with iatrogenic colonic perforations after sigmoido/colonoscopy between 1990 and 2005. The patientsÕ demographic data, endoscopic procedural information, perforation location, therapy, and outcome were recorded. Results: In the 16-year period, 30,366 endoscopic colonic procedures were performed. In total, 35 colonic perforations occured (0.12%). All the patients underwent a laparotomy: for primary repair in 18 cases (56%), for resection with anastomosis in 8 cases (25%), and for resection without anastomosis in 6 cases (19%). In three patients (8.6%), no perforation was found. The postoperative course was uncomplicated in 21 cases (60%) and complicated in 14 cases (40%), including mortality for 3 patients (8.6% resulting from perforations and 0.01% resulting from total endoscopic colon procedures). The relative risk ratio of colonoscopic and sigmoidoscopic procedures for perforations was 4. Therapeutic procedures show a delay in presentation and diagnosis compared with diagnostic procedures. Of the 35 perforations, 26 (74%) occurred in the sigmoid colon. Conclusion: Iatrogenic colonic perforation is a serious but rare complication of colonoscopy. A perforation risk of 0.12% was found. The perforation risk was higher for colonoscopic procedures than for sigmoidoscopic procedures. The sigmoid colon is the area at greatest risk for perforation. Immediate operative management, preferably primary repair and sometimes resection, appears to be a good strategy for most patients. Key words: Colon perforation -ColonoscopyComplication -Endoscopy -IatrogenicColonic perforation resulting from colonoscopic and sigmoidoscopic procedures is a rare but serious complication with high rates of morbidity and mortality [1,3,6,7,12]. The frequency of perforations after colonoscopy is estimated to be 0.03% to 0.8% for diagnostic colonoscopy and 0.15% to 3% for therapeutic colonoscopy [22]. With increasing numbers of colonoscopies being performed for screening purposes, this small possibility of perforations still may cause a high number of clinical problems. The optimal treatment for perforations, whether conservative or operative, still is unclear because no randomized trial has ever been conducted.Recent studies are acquiring evidence for laparoscopic and endoluminal repair using clips for perforation closure [15-17, 19, 22]. Knowing risk factors, recognizing early signs of perforation, and giving early and optimal treatment may reduce the probability of (severe) complications and death from iatrogenic colon perforations. In this report, we re...

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Section: Discussionmentioning

confidence: 99%

Colonoscopic perforations: a review of 30,366 patients

et al. 2007

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“…La colonoscopia es el método diagnóstico fundamental del CCR. Diversos estudios han demostrado que su realización es técnicamente más difícil en mujeres que en hombres por varios motivos (Church, 1994;Saunders et al, 1996). El primero de ellos es que la longitud del colon es mayor en mujeres (unos 10 cm más en promedio), y esto implica mayor probabilidad de bucles del intestino, mayor tiempo de exploración, mayor insuflación de aire intra-colónico, mayor dolor y requerimientos de sedación durante el procedimiento, y mayor riesgo de complicaciones (Hanson et al, 2007;Khashab et al, 2009).…”

Section: Estrategias De Cribado Y Diagnóstico Pre-coz Del Cáncer Colounclassified

El cáncer colorrectal en la mujer

García‐Carbonero¹

2015

Arbor

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RESUMEN: El cáncer colorrectal (CCR) es el tercer tumor más frecuente en el mundo. Los datos epidemiológicos demuestran que tanto la incidencia como la mortalidad debidos a este tumor son menores en las mujeres que en los hombres. De hecho, numerosos estudios observacionales y experimentales sugieren que los estrógenos, tanto endógenos como exógenos, podrían jugar un papel protector relevante. En este artículo se van a discutir las diferencias epidemiológicas y sociológicas del CCR en función del género, algunas peculiaridades y barreras específicas para la prevención y el diagnóstico precoz del CCR en la mujer, y aspectos particulares de género sobre el impacto de las diversas terapias antineoplásicas, como son cirugía, radioterapia y quimioterapia, en la función sexual, la continencia esfinteriana y la calidad de vida de las mujeres.PALABRAS CLAVE: calidad de vida; diagnóstico; estrógenos; prevención.ABSTRACT: Colorectal cancer (CRC) is the third most common tumour in the world. Epidemiological data demonstrate that both the incidence and mortality of CRC is lower in women than in men. In fact, several observational and experimental studies suggest that oestrogens, both endogenous and exogenous, could play a relevant protective role. In this article, we discuss the epidemiological and sociological differences regarding gender in CRC, some particularities and specific barriers for the prevention and early diagnosis of CRC in women, as well as particular aspects of gender regarding the impact of the various antineoplastic therapies, such as surgery, radiotherapy and chemotherapy, sexual function, sphincter continence and quality of life in women.

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“…It is generally accepted that caecal intubation rates (CIR) should be greater than 90% for both screening and diagnostic endoscopies (1)(2)(3). Among the factors that have been recognized that affect CIR are body mass index, age of the patients, quality of bowel preparation, gender of the patients, experience of the endoscopist, prior hysterectomy in female patients and history of constipation (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Comparison of caecal intubation rates between morning and afternoon colonoscopies at a tertiary hospital in Southwest Nigeria

Akere¹,

Osundina²,

Tejan³

2018

Research Journal of Health Sciences

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Background: Caecal intubation is an important measure of the quality of colonoscopy. Information on the effect of the time of colonoscopy on caecal intubation rate (CIR) is scarce. This study aimed to compare the CIR between morning and afternoon colonoscopies at the University College Hospital, Ibadan, Nigeria.Methods: A descriptive study of consenting patients referred for colonoscopy at the endoscopy unit of the University College Hospital, Ibadan, from January 2016 to March 2017. Bowel preparation consisted of liquid diet and Epsom salt. Pre-medications were intravenous Midazolam 2.5-5 mg and Pentazocine 15-30 mg in titrated doses. Colonoscopy was performed using Olympus Exera III Videocolonoscope (CF HQ190L, Olympus UK). Morning procedures were those carried out between 8.30 am and 12.00 noon, while those after 12.00 noon were classified as afternoon procedures. Caecal intubation was considered successful when the medial wall of the caecum was visualized.Results: Total of 177 colonoscopies were performed with 115 (65%) performed in the morning and 62 (35%) in the afternoon. In the morning, median age was 60 yrs, while in the afternoon, it was 61 yrs. Males (60.9% vs 58.1%) predominated in the morning, whereas females predominated in the afternoon (41.9% vs 39.1%), (p=0.72). In the morning, 100 (87%) patients had good/satisfactory bowel preparation, but 52 (83.9%) patients in the afternoon.(p=0.57). CIR was higher in the morning (90.4%), compared to afternoon (88.7%) (p=0.72). Conclusion:There was no statistically significant difference between CIR in the morning and afternoon procedures. Résultats: Au total, 177 coloscopies ont été réalisées avec 115 (65%) effectuées le matin et 62 (35%) l'après-midi. Le matin, l'âge médian était de 60 ans, alors que l'après-midi, il était de 61 ans. Les mâles (60,9% vs 58,1%) prédominaient le matin, tandis que les femelles prédominaient l'après-midi (41,9% vs 39,1%) (p = 0,72). Le matin, 100 patients (87%) avaient une préparation intestinale satisfaisante / satisfaisante, mais 52 patients (83,9%) l'après-midi (p = 0,57). Le CIR était plus élevé le matin (90,4%) que l'après-midi (88,7%) (p = 0,72). Keywords Conclusion:Il n'y avait pas de différence statistiquement significative entre CIR dans les procédures du matin et de l'après-midi.

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Why is colonoscopy more difficult in women?

Cited by 241 publications

References 4 publications

Colonoscopic perforations: a review of 30,366 patients

Colonoscopic perforations: a review of 30,366 patients

El cáncer colorrectal en la mujer

Comparison of caecal intubation rates between morning and afternoon colonoscopies at a tertiary hospital in Southwest Nigeria

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