Introduction Colonoscopy is the gold standard assessment for large bowel mucosal pathology, but a complete examination is an essential requirement. Higher caecal intubation rates in male patients vs female patients have been shown in the literature.1–3 Several theories are mooted for this difference such as female patients undergoing previous hysterectomy,1 low BMI2 and the suggestion that female patients have longer colons.3 The published papers on this subject are mostly over 10 years old and colonoscopy practice has changed dramatically over the last decade in the UK. The Joint Advisory Group on Gastrointestinal endoscopy (JAG) has run a programme of continuous quality improvement by standardising training, peer review and audit. The Bowel Cancer Screening Programme (BCSP) has been rolled out since 2006. This large audit revisits this subject to see if the improvements in colonoscopic practice have evened out the differences.
Methods Data were collected from all colonoscopies undertaken (symptomatic, surveillance and BCSP procedures) at Kettering General Hospital between 1 July 2007 and 30 June 2011.
|Number of colonoscopies||Reached caecum/TI/anastomosis||Failed||CIR (%)||95% CI|
|Females||2440||2138||302||87.62||86.26 to 88.87|
|Males||2772||2524||198||92.73||91.69 to 93.64|
|Total||5162||4662||500||90.31||89.48 to 91.09|
Conclusion Analysis of the data reveals significant differences in CIR between female and male patients (87.62% vs 92.73% (p≤0.0001) NNT 19.57). This large retrospective audit shows despite the improvements in training and practice overseen by JAG and the introduction of BCSP, significant gender differences remain in CIR. Perhaps it would be prudent for endoscopy units to delineate these differences in gender and the potential ramifications (missed polyps etc) when giving information and consenting patients for colonoscopy. Further analysis of the reasons resulting in gender differences in CIR and the impact on morbidity and mortality due to missed pathology would be desirable.
Competing interests None declared.
References 1. Church JM. Complete colonoscopy: How often? And if not, why not? Am J Gastroenterol 1994;89:556–60.
2. Anderson JC, Gonzalez JD, Messina CR, et al. Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol 2000;95:2784–7.
3. Saunders BP, Fukumoto M, Halligan S, et al. Why is colonoscopy more difficult in women? Gastrointest Endosc 1996;43:124–6.
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