Patient factors associated with a faster insertion of the colonoscope

Background: There are many factors involved in a difficult colonoscopy. Our hypothesis is that colonic intubation is more difficult in thin patients. We consider it beneficial to know a priori who would be in need of specialized equipment or maneuvers for a successful colonoscopy. Methods: Over two years, 435 consecutive patients who underwent elective colonoscopy by one surgeon were included in this prospective study. Patients who underwent prior colectomy, who had cancer other than that of the cecum, or who had had an emergent endoscopy were excluded from the study. The time it took to insert the colonoscope from the anus to the cecum was recorded and rounded to the nearest minute. For statistical analysis, we considered gender, age, body mass index (BMI), abdominal girth, diagnosis, presence or absence of prior pelvic surgery, need for external compression, and quality of the bowel preparation. The Mann-Whitney test was used to compare the median time of intubation between males and females. Results: There was no statistically significant correlation between the BMI, abdominal girth, presence or absence of prior abdominal or pelvic surgery, and the length of insertion of the endoscope. Statistical significance was reached between the male and female. The median time to insert the colonoscope in the males was 7 min (mean = 8.14 min), while in females it was 10 min (mean = 10.6 min). Conclusions: Females had a significantly longer time of insertion of the colonoscope compared to males. Neither abdominal girth nor body mass seems to reflect the volume of the peritoneal cavity. It seems possible that there is a content-container mismatch in thin female patients. We suggest repeating the study using other anthropometric measurements to calculate the intraperitoneal volume. This may help select the patients who would benefit from a deeper sedation or more specialized equipment.