The impact of visceral adipose tissue as best predictor for difficult colonoscopy and the clinical utility of a long small-caliber scope as rescue
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...
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| Veröffentlicht in: | PloS one 2017-12, Vol.12 (12), p.e0189817-e0189817 |
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| creator | Kashiwagi, Kazuhiro Inoue, Nagamu Yoshida, Toshifumi Bessho, Rieko Yoneno, Kazuaki Imaeda, Hiroyuki Ogata, Haruhiko Kanai, Takanori Sugino, Yoshinori Iwao, Yasushi |
| description | 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.
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.
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.
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. |
| doi_str_mv | 10.1371/journal.pone.0189817 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0189817</identifier><identifier>PMID: 29267320</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abdomen ; Adipose tissue ; Adult ; Age ; Analysis ; Anesthesia ; Biology and Life Sciences ; Body fat ; Body mass ; Cecum ; Colon ; Colonoscopy ; Colonoscopy - instrumentation ; Conditioned stimulus ; Diagnostic equipment (Medical) ; Endoscopy ; Family medical history ; Female ; Gastroenterology ; Gender ; Health aspects ; Hepatology ; Hospitals ; Humans ; Internal medicine ; Intra-Abdominal Fat ; Intubation ; Male ; Medical screening ; Medicine and Health Sciences ; Methods ; Multivariate analysis ; Obesity ; Pain ; Patient outcomes ; Physical Sciences ; Polyethylene glycol ; Preventive medicine ; Redundancy ; Regression analysis ; Research and Analysis Methods ; Surgery ; Tomography ; Tortuosity ; Transportation services</subject><ispartof>PloS one, 2017-12, Vol.12 (12), p.e0189817-e0189817</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Kashiwagi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Kashiwagi et al 2017 Kashiwagi et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-619b74f55ca18b4a98b9c37d6f7c8ac03c53be45264590847cb97f7ce171b62a3</citedby><cites>FETCH-LOGICAL-c692t-619b74f55ca18b4a98b9c37d6f7c8ac03c53be45264590847cb97f7ce171b62a3</cites><orcidid>0000-0002-6301-1466</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739452/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739452/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29267320$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Green, John</contributor><creatorcontrib>Kashiwagi, Kazuhiro</creatorcontrib><creatorcontrib>Inoue, Nagamu</creatorcontrib><creatorcontrib>Yoshida, Toshifumi</creatorcontrib><creatorcontrib>Bessho, Rieko</creatorcontrib><creatorcontrib>Yoneno, Kazuaki</creatorcontrib><creatorcontrib>Imaeda, Hiroyuki</creatorcontrib><creatorcontrib>Ogata, Haruhiko</creatorcontrib><creatorcontrib>Kanai, Takanori</creatorcontrib><creatorcontrib>Sugino, Yoshinori</creatorcontrib><creatorcontrib>Iwao, Yasushi</creatorcontrib><title>The impact of visceral adipose tissue as best predictor for difficult colonoscopy and the clinical utility of a long small-caliber scope as rescue</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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.
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.
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.</description><subject>Abdomen</subject><subject>Adipose tissue</subject><subject>Adult</subject><subject>Age</subject><subject>Analysis</subject><subject>Anesthesia</subject><subject>Biology and Life Sciences</subject><subject>Body fat</subject><subject>Body mass</subject><subject>Cecum</subject><subject>Colon</subject><subject>Colonoscopy</subject><subject>Colonoscopy - instrumentation</subject><subject>Conditioned stimulus</subject><subject>Diagnostic equipment (Medical)</subject><subject>Endoscopy</subject><subject>Family medical history</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gender</subject><subject>Health aspects</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Internal medicine</subject><subject>Intra-Abdominal Fat</subject><subject>Intubation</subject><subject>Male</subject><subject>Medical screening</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Multivariate analysis</subject><subject>Obesity</subject><subject>Pain</subject><subject>Patient outcomes</subject><subject>Physical Sciences</subject><subject>Polyethylene glycol</subject><subject>Preventive medicine</subject><subject>Redundancy</subject><subject>Regression analysis</subject><subject>Research and Analysis Methods</subject><subject>Surgery</subject><subject>Tomography</subject><subject>Tortuosity</subject><subject>Transportation 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Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kashiwagi, Kazuhiro</au><au>Inoue, Nagamu</au><au>Yoshida, Toshifumi</au><au>Bessho, Rieko</au><au>Yoneno, Kazuaki</au><au>Imaeda, Hiroyuki</au><au>Ogata, Haruhiko</au><au>Kanai, Takanori</au><au>Sugino, Yoshinori</au><au>Iwao, Yasushi</au><au>Green, John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of visceral adipose tissue as best predictor for difficult colonoscopy and the clinical utility of a long small-caliber scope as rescue</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-12-21</date><risdate>2017</risdate><volume>12</volume><issue>12</issue><spage>e0189817</spage><epage>e0189817</epage><pages>e0189817-e0189817</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29267320</pmid><doi>10.1371/journal.pone.0189817</doi><tpages>e0189817</tpages><orcidid>https://orcid.org/0000-0002-6301-1466</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2017-12, Vol.12 (12), p.e0189817-e0189817 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1980701432 |
| source | MEDLINE; Full-Text Journals in Chemistry (Open access); Public Library of Science; DOAJ Directory of Open Access Journals; PubMed Central; EZB Electronic Journals Library |
| subjects | Abdomen Adipose tissue Adult Age Analysis Anesthesia Biology and Life Sciences Body fat Body mass Cecum Colon Colonoscopy Colonoscopy - instrumentation Conditioned stimulus Diagnostic equipment (Medical) Endoscopy Family medical history Female Gastroenterology Gender Health aspects Hepatology Hospitals Humans Internal medicine Intra-Abdominal Fat Intubation Male Medical screening Medicine and Health Sciences Methods Multivariate analysis Obesity Pain Patient outcomes Physical Sciences Polyethylene glycol Preventive medicine Redundancy Regression analysis Research and Analysis Methods Surgery Tomography Tortuosity Transportation services |
| title | The impact of visceral adipose tissue as best predictor for difficult colonoscopy and the clinical utility of a long small-caliber scope as rescue |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-17T17%3A50%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20impact%20of%20visceral%20adipose%20tissue%20as%20best%20predictor%20for%20difficult%20colonoscopy%20and%20the%20clinical%20utility%20of%20a%20long%20small-caliber%20scope%20as%20rescue&rft.jtitle=PloS%20one&rft.au=Kashiwagi,%20Kazuhiro&rft.date=2017-12-21&rft.volume=12&rft.issue=12&rft.spage=e0189817&rft.epage=e0189817&rft.pages=e0189817-e0189817&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0189817&rft_dat=%3Cgale_plos_%3EA519847520%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1980701432&rft_id=info:pmid/29267320&rft_galeid=A519847520&rft_doaj_id=oai_doaj_org_article_609b7ad0b28f4f728b4688289182bddc&rfr_iscdi=true |