Original Article
A prospective study of factors that determine cecal intubation time at colonoscopy

https://doi.org/10.1016/S0016-5107(04)02461-7Get rights and content

Background

For outpatient colonoscopy, the time required to intubate the cecum is variable. The aim of this study was to determine factors associated with cecal intubation time.

Methods

A total of 693 consecutive outpatient colonoscopies performed from January to October 2002 at a tertiary care medical center were studied prospectively. Data gathered included time required to reach the cecum; patient age, gender, and body mass index; history of abdominal surgery; quality of bowel preparation; presence/absence of diverticula; and endoscopist experience.

Results

Complete data were available for 587 patients. Mean age was 59 years, 48% were men, and mean body mass index was 28. Median cecal intubation time was 9 minutes. Linear regression analysis was performed. Cecal intubation time is prolonged by the following factors: older patient age, female gender, lower body mass index, poor bowel preparation, and lower endoscopist annual case volume.

Conclusions

This large, prospective study identified 5 factors that prolong the time required for cecal intubation at colonoscopy. These factors may be used to individualize scheduling of colonoscopy according to the time required.

Section snippets

Patients and methods

A prospective study was performed of consecutive outpatients undergoing elective outpatient colonoscopy at a university-affiliated tertiary care medical center from January to October 2002. The indication for most of the procedures was colorectal cancer/polyp screening or surveillance for polyps. All colonoscopies were performed by using standard videocolonoscopes. The study was approved by the institutional review board of our medical center, and patients provided written informed consent

Results

Thirteen patients (1.8%) refused to participate. Partial data were available for 693 colonoscopies; complete data for 587 colonoscopies were available for regression analyses. Summary data for these patients are shown in Table 1. Mean patient age was 69 years (range 23-91 years); 48% of the patients were men and 52% were women. Mean BMI was 27.8 (range 15.1-69.1), 51% had no history of surgery, 27% had undergone operations with a low risk of adhesions, and 22% had undergone operations with a

Discussion

In this study of outpatients undergoing colonoscopy at a tertiary care referral center, the time required for cecal intubation was most strongly associated with the quality of bowel preparation. Previous studies have found that colonoscopy is significantly more difficult in women than in men.4, 5, 6 It also has been demonstrated that colonoscopy completion rate is lower in women, in patients younger than 20 years of age, in patients older than 80 years, and in patients who have undergone

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See CME Section; p. 127.

Grant support for this study was provided by the American Society for Gastrointestinal Endoscopy.

Presented in abstract form at Digestive Diseases Week American Society for Gastrointestinal Endoscopy meeting, May 18-21, 2003, Orlando, Florida (Gastroenterology 2003;124(4 Suppl 1).

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