Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7834
Peer-review started: October 28, 2014
First decision: December 26, 2014
Revised: April 3, 2015
Accepted: May 21, 2015
Article in press: May 21, 2015
Published online: July 7, 2015
AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.
METHODS: In this cross-sectional study, 517 difficult colonoscope insertions (Grade C, Kudo’s difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4th-level (Kudo’s classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient’s discomfort or pain, severe colon disease with a perforation risk (e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient’s age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time (> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.
RESULTS: Three hundred and twenty-two (62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195 (37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation (OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity (OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation (OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity (OR 0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy (OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex (OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time (> 10 min) was an unfavorable factor for the insertion into the ileocecum.
CONCLUSION: Colonoscopy should be discontinued if freedom of the colonoscope body’s insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.
Core tip: This original article investigated when and why a colonoscopist should discontinue incomplete colonoscopy by himself. If freedom of the colonoscope body’s insertion and rotation is lost because of unfavorable factors, such as fixation, tortuosity, laxity, and redundancy occurring in the colon, and the insertion time is prolonged > 30 min after repeated attempts by the 4th-level colonoscopists, we suggest the colonoscopy should be discontinued by the colonoscopist.