Anatomy-related ratios predict colonoscopy incompleteness in similar examination conditions.

BACKGROUND Screening colonoscopy is one of the most popular modalities for screening and surveillance of colorectal cancer and other colon disorders. OBJECTIVES To introduce new ratios to predict the colonoscopy course in patients with similar characteristics. MATERIAL AND METHODS Five hundred screening colonoscopies (252 females and 248 males) were performed by an experienced endoscopist. Incomplete colonoscopies (without pathologic findings, i.e., disease-unrelated) were included in the study. Collected data was used to determine new ratios. RESULTS An examination was completed in 231 (91.7%) females (F) and 239 (96.4%) males (M). The majority of incomplete colonoscopies were discontinued in the sigmoid colon: 8 F (38.1%) and 4 M (44.4%) or in the descendosigmoid flexure: 4 F (19%) and 2 M (22.2%). We found statistically significant higher risk of incompleteness in females (p = 0.03), patients after 2 or more surgical treatments (p = 0.007) and in males with lower body mass index (BMI) (p = 0.01) (χ2 tests). Moreover, we discovered a statistically significant correlation with 2 or more previous surgical treatments in the female group (p = 0.02) (χ2 test). We calculated the incomplete colonoscopy anatomy-related (ICAR) and modified ICAR (MICAR) ratios. The range of ICAR and MICAR was 0-0.17; the number of incomplete examinations ranged from 0 to 1 failed out of 6 attempts (calculation: 100:17 = 5.88). CONCLUSIONS The ICAR and MICAR ratios reflect the various risk of colonoscopy incompleteness (i.e., disease-unrelated) and highlight the differences between patients in similar examination condition.

[1]  F. Paulsen,et al.  The large intestine from fetal period to adulthood and its impact on the course of colonoscopy. , 2019, Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft.

[2]  B. Puła,et al.  New colon anatomy-related ratios used to predict the course of colonoscopy in children. , 2019, Advances in clinical and experimental medicine : official organ Wroclaw Medical University.

[3]  N. Sandhu,et al.  New Developments in Mechanical Enhancement of Colonoscopy: Cuffs, Caps and Rings , 2016, Digestion.

[4]  M. Floer,et al.  Endoscopic Improvement of the Adenoma Detection Rate during Colonoscopy - Where Do We Stand in 2015? , 2016, Digestion.

[5]  P. Culmer,et al.  Quantitative assessment of colorectal morphology: Implications for robotic colonoscopy. , 2016, Medical engineering & physics.

[6]  M. Phillips,et al.  Segmental colonic length and mobility. , 2015, Annals of the Royal College of Surgeons of England.

[7]  Tao Gan,et al.  When and why a colonoscopist should discontinue colonoscopy by himself? , 2015, World journal of gastroenterology.

[8]  David H. Kim,et al.  Volumetric analysis of colonic distention according to patient position at CT colonography: diagnostic value of the right lateral decubitus series. , 2014, AJR. American journal of roentgenology.

[9]  J. Coffey,et al.  The Effect of Hysterectomy on Colonoscopy Completion: A Systematic Review and Meta-Analysis , 2014, Diseases of the colon and rectum.

[10]  M. Noda,et al.  Predictors for Cecal Insertion Time: The Impact of Abdominal Visceral Fat Measured by Computed Tomography , 2014, Diseases of the colon and rectum.

[11]  H. Kang,et al.  Factors that determine prolonged cecal intubation time during colonoscopy: impact of visceral adipose tissue , 2014, Scandinavian journal of gastroenterology.

[12]  H. Brenner,et al.  Reduced risk of colorectal cancer up to 10 years after screening, surveillance, or diagnostic colonoscopy. , 2014, Gastroenterology.

[13]  A. Nawras,et al.  Body mass index predicts cecal insertion time: The higher, the better , 2012, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[14]  D. Lieberman,et al.  Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12 134 examinations (Berlin colonoscopy project 3, BECOP-3) , 2012, Gut.

[15]  J. Church,et al.  History of Hysterectomy: A Significant Problem for Colonoscopists That Is Not Present in Patients Who Have Had Sigmoid Colectomy , 2010, Diseases of the colon and rectum.

[16]  E. Jolicoeur,et al.  Effect of hysterectomy on colonoscopy completion rate. , 2010, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[17]  Dirk Hartmann,et al.  Colon anatomy based on CT colonography and fluoroscopy: impact on looping, straightening and ancillary manoeuvres in colonoscopy. , 2010, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[18]  David H. Kim,et al.  Colorectal anatomy in adults at computed tomography colonography: normal distribution and the effect of age, sex, and body mass index , 2009, Endoscopy.

[19]  D. Rex.  Achieving cecal intubation in the very difficult colon. , 2008, Gastrointestinal endoscopy.

[20]  Y. Hsieh,et al.  Factors that predict cecal insertion time during sedated colonoscopy: The role of waist circumference , 2008, Journal of gastroenterology and hepatology.

[21]  David H. Kim,et al.  Anatomic factors predictive of incomplete colonoscopy based on findings at CT colonography. , 2007, AJR. American journal of roentgenology.

[22]  T. Stukel,et al.  Factors associated with incomplete colonoscopy: a population-based study. , 2007, Gastroenterology.

[23]  A. McCullough,et al.  Afternoon Colonoscopies Have Higher Failure Rates than Morning Colonoscopies , 2006, The American Journal of Gastroenterology.

[24]  Syed G. Shah,et al.  Magnetic imaging of colonoscopy: an audit of looping, accuracy and ancillary maneuvers. , 2000, Gastrointestinal endoscopy.

[25]  S Halligan,et al.  Why is colonoscopy more difficult in women? , 1996, Gastrointestinal endoscopy.

[26]  Paul Fockens,et al.  Mechanical analysis of insertion problems and pain during colonoscopy: why highly skill-dependent colonoscopy routines are necessary in the first place... and how they may be avoided. , 2013, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[27]  S. Sadahiro,et al.  Analysis of length and surface area of each segment of the large intestine according to age, sex and physique , 2005, Surgical and Radiologic Anatomy.