The impact of visceral adipose tissue as best predictor for difficult colonoscopy and the clinical utility of a long small-caliber scope as rescue

Kazuhiro Kashiwagi; Nagamu Inoue; Toshifumi Yoshida; Rieko Bessho; Kazuaki Yoneno; Hiroyuki Imaeda; Haruhiko Ogata; Takanori Kanai; Yoshinori Sugino; Yasushi Iwao

doi:10.1371/journal.pone.0189817

The impact of visceral adipose tissue as best predictor for difficult colonoscopy and the clinical utility of a long small-caliber scope as rescue

PLoS One. 2017 Dec 21;12(12):e0189817. doi: 10.1371/journal.pone.0189817. eCollection 2017.

Affiliations

¹ Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
³ Department of General Medicine, Saitama Medical University School of Medicine, Saitama, Japan.
⁴ Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan.

Abstract

Background: There have been many reports about a variety of factors associated with incomplete colonoscopy or difficult colonoscopy with long cecal intubation time (CIT). The aim of this retrospective study was to analyze the factors related to difficult colonoscopy under conscious sedation and demonstrate the clinical utility of a small-caliber scope as rescue by using the data from a large number of subjects who underwent health check-ups.

Methods: Consecutive 1036 cases over a 12-month period (April 2015 to March 2016) were enrolled and 619 subjects were divided into two groups: Easy colonoscopy (CS) Group (CIT ≤ 10 min); Difficult CS Group (CIT > 10 min or incomplete colonoscopy by a standard scope). The two groups were compared by subjects and colonoscopy characteristics with univariate analysis followed by multivariate logistic regression analysis. Reasons for incomplete colonoscopy were also assessed.

Results: Cecal intubation rate increased from 97.9% to 99.9% (1007/1008) by the rescue scope. Main reasons for incomplete colonoscopy were tortuosity in the left hemicolon (38%), redundancy in the right hemicolon (29%), pain (19%) and fixation (14%). Moreover, 95% (20/21) of rescue colonoscopies were completed without additional sedation. Higher BMI (21 kg/m2 ≤ BMI) and intermediate visceral adipose tissue (VAT) (75 cm2 ≤ VAT < 150 cm2) were significantly associated with easy CS (80.7% vs 19.3%, P = 0.004; 56.3% vs 43.7%, P = 0.001) by univariate analysis. Age, gender, and VAT, not BMI, were independently associated with difficult colonoscopy by multivariate analysis (OR (95% CI), P: 0.964 (0.942, 0.985), 0.001; 1.845 (1.101, 3.091), 0.020; 2.347 (1.395, 3.951), 0.001). Subgroup analysis by gender also showed VAT as the best predictor for both genders.

Conclusion: Difficult colonoscopy was significantly associated with advancing age, female gender and, lower (< 75 cm2) or higher (150 cm2 ≤) VAT. These subjects may benefit from having complete and more comfortable colonoscopy examinations by using the small-caliber scope rather than the standard scope.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Colonoscopy / instrumentation*
Female
Humans
Intra-Abdominal Fat*
Male

Grants and funding

KK received funding from Grants-in-Aid for Scientific Research (grant number: 16K09290; URL: https://www.jsps.go.jp/j-grantsinaid/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.