Case Control Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2017; 23(13): 2346-2354
Published online Apr 7, 2017. doi: 10.3748/wjg.v23.i13.2346
Predictors for difficult cecal insertion in colonoscopy: The impact of obesity indices
Soo Yun Moon, Byung Chang Kim, Dae Kyung Sohn, Kyung Su Han, Bun Kim, Chang Won Hong, Bum Joon Park, Kum Hei Ryu, Ji Hyung Nam
Soo Yun Moon, Byung Chang Kim, Dae Kyung Sohn, Kyung Su Han, Bun Kim, Chang Won Hong, Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Gyeonggi-do 10408, South Korea
Byung Chang Kim, Dae Kyung Sohn, Kyung Su Han, Bun Kim, Chang Won Hong, Bum Joon Park, Kum Hei Ryu, Ji Hyung Nam, Center for Cancer Prevention and Detection, Research Institute and Hospital, National Cancer Center, Gyeonggi-do 10408, South Korea
Soo Yun Moon, Department of Surgery, School of Medicine, Kyung Hee University, Seoul 02447, South Korea
Author contributions: Moon SY collected and analyzed the data, and drafted the manuscript; Kim BC provided analytical oversight; Kim BC designed and supervised the study; Sohn DK, Han KS, Kim B, Hong CW, Park BJ, Ryu KH and Nam JH revised the manuscript for important intellectual content; Moon SY, Kim BC, Sohn DK, Han KS, Kim B and Hong CW provided administrative support; all authors have read and approved the final version to be published.
Supported by National Cancer Center, South Korea, No. NCC-1610250, No. NCC-1410250, and No. NCC 0810200-1.
Institutional review board statement: This study was approved by the institutional review board of National Cancer Center, Korea (NCC2016-0217).
Informed consent statement: This study is exempt from informed consent, since it is a retrospective study and the data collection and analysis were carried out without disclosing patient’s identity.
Conflict-of-interest statement: All authors declare that there are no potential conflicting interests related to the submitted manuscript.
Data sharing statement: There are no available additional data.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Byung Chang Kim, MD, Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, South Korea. mdzara@ncc.re.kr
Telephone: +82-31-9201649 Fax: +82-31-9202624
Received: November 21, 2016
Peer-review started: November 23, 2016
First decision: December 28, 2016
Revised: January 16, 2017
Accepted: February 17, 2017
Article in press: February 17, 2017
Published online: April 7, 2017
Abstract
AIM

To identify the factors influencing cecal insertion time (CIT) and to evaluate the effect of obesity indices on CIT.

METHODS

We 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.

RESULTS

A 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).

CONCLUSION

Being female, having a lower or higher BMI than the normal range, a low VAT volume, and fellow involvement were predictors of a longer CIT.

Keywords: Visceral obesity, Difficult colonoscopy, Cecal insertion time, Body mass index, Female

Core tip: There are well known predictive factors of longer cecal intubation time (CIT). Old age, female, poor quality of bowel preparation, history of prior abdominal surgery, trainee, diverticulosis and constipation are associated with longer CIT. A low visceral adipose tissue (VAT) volume, female, having a lower or higher body mass index, and fellow involvement were predictors of a longer CIT based on the present study. Especially, low VAT volume was associated with prolonged CIT in only women.