Sex difference in bowel preparation quality and colonoscopy time

Hwang, Young Jin; Shin, Dong Woo; Kim, Nayoung; Yoon, Hyuk; Shin, Cheol Min; Park, Young Soo; Lee, Dong Hoon

doi:10.3904/kjim.2019.040

Cited by 15 publications

(14 citation statements)

References 43 publications

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“…11,13,[19][20][21][22] The difference in cecal insertion time between males and females might originate from anatomical differences. Compared with males, females have a longer colon, less visceral fat and abdominal muscle to support the colon, and a deeper pelvis, 13,[23][24][25] all of which predispose to loop formation during colonoscopy. 13,[23][24][25] Patients with lower BMI have less visceral fat to support the colon to prevent looping and a smaller abdominal cavity and thus more acute bends of the colon.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with males, females have a longer colon, less visceral fat and abdominal muscle to support the colon, and a deeper pelvis, 13,[23][24][25] all of which predispose to loop formation during colonoscopy. 13,[23][24][25] Patients with lower BMI have less visceral fat to support the colon to prevent looping and a smaller abdominal cavity and thus more acute bends of the colon. 20,26 A history of constipation and less experienced endoscopist were also associated with longer insertion times in previous studies.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with prolonged cecal insertion time in patients undergoing water exchange colonoscopy

Hsieh

Koo

Tseng

2022

J of Gastro and Hepatol

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Background and Aim Water exchange is superior to air insufflation in reducing discomfort and increasing adenoma detection during colonoscopy. However, prolonged cecal insertion time is a drawback. This study aims to investigate the factors affecting cecal insertion during water exchange colonoscopy. Methods We pooled data from five randomized clinical trials that included patients undergoing water exchange colonoscopy. Logistic analysis was performed to determine the independent factors associated with prolonged cecal insertion time (> 15 min). Results The cohort included 912 patients (493 men and 419 women) with a median age of 57 years (interquartile range, 49–64 years). The median cecal insertion time was 13.5 min (interquartile range, 10.9–17.0 min). Multivariate logistic regression analysis indicated that female sex, body mass index < 25 kg/m2, a history of constipation, no sedation, less experienced endoscopist, Boston Bowel Preparation Scale score ≤ 6, infused water volume during insertion ≥ 1000 mL, and scope length at the cecum ≥ 85 cm were associated with prolonged cecal insertion time. With increasing volume of infused water (1000–2000 mL), the median cecal insertion time increased gradually from 11.4 to 23.0 min (P < 0.001). Conclusions The current study identified independent factors associated with prolonged cecal insertion time during water exchange colonoscopy. Several factors are modifiable to achieve a shorter insertion time, including better bowel preparation, the use of sedation, more experienced endoscopist, infusing less water during insertion, and maintaining a shorter scope length.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors associated with prolonged cecal insertion time in patients undergoing water exchange colonoscopy

Hsieh

Koo

Tseng

2022

J of Gastro and Hepatol

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“…Age, sex, physical activity, socioeconomic status, educational level, and comorbidity may significantly affect colonoscopy quality 1,60,61 . Predictors of poor BP include age (odds ratio [OR] = 1.14), tobacco use (OR = 1.28), narcotic use (OR = 1.28), hypertension (OR = 1.25), diabetes mellitus (OR = 1.38), obesity (OR = 1.46), low education (OR = 1.49), dementia (OR = 2.09), and calcium‐channel blockers (OR = 3.2), as reported in different reviews and meta‐analyses 61–64 . Hospitalization is another independent predictor of poor BP 65 .…”

Section: Patient Factorsmentioning

confidence: 99%

“… 1 , 60 , 61 Predictors of poor BP include age (odds ratio [OR] = 1.14), tobacco use (OR = 1.28), narcotic use (OR = 1.28), hypertension (OR = 1.25), diabetes mellitus (OR = 1.38), obesity (OR = 1.46), low education (OR = 1.49), dementia (OR = 2.09), and calcium‐channel blockers (OR = 3.2), as reported in different reviews and meta‐analyses. 61 , 62 , 63 , 64 Hospitalization is another independent predictor of poor BP. 65 A recent Italian multicenter study developed and validated a model to identify hospitalized patients with inadequate bowel cleansing.…”

Section: Patient Factorsmentioning

confidence: 99%

The unmet needs for identifying the ideal bowel preparation

et al. 2021

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Colonoscopy, since it was first employed over 60 years ago, is now the gold standard method for visualizing the mucosa of the colon, but should be of good quality. Many factors affect quality, including the type of health service organization, type of facility, staff, equipment, patient characteristics, and bowel preparation (BP). The adequacy of bowel cleansing is critical, but, unfortunately, may be inadequate in up to one‐third of procedures. The current article will present and discuss the main BPs and their drawbacks, which include patient‐dependent and procedure‐dependent factors. Cleansing quality depends on the ease/complexity of solution preparation, volume, taste, and timing of consumption. Consequently, important positive factors include simple instructions, easy preparation of the solution, low volume, pleasant taste, short drinking time (e.g. <30 min), and splitting the dose between the evening before and the morning of the colonoscopy (or even better, only one dose in the early morning to avoid night‐time problems), and short onset of action. The BP solution must also be safe with negligible side effects. Furthermore, a positive experience supports patient willingness to repeat the procedure.

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“…Previous studies have found that age, sex, physical activity, daily bowel movements, being examined in the afternoon, the time between finishing bowel preparation and examination, split dose and different education methods were associated with bowel preparation quality. [ 2 , 5 ] Although education and timing of bowel preparation were influential,[ 2 ] there is no clear consensus on the relative importance of these factors. A national CRC screening programme in China, initiated in 2018, provided data for secondary analysis to explore the factors which could improve bowel preparation quality before colonoscopy.…”

Section: Introductionmentioning

confidence: 99%

Graphical education and appropriate time before elective colonoscopy make better bowel preparation

Sun

Chen

et al. 2022

Journal of Minimal Access Surgery

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Background: Inadequate bowel preparation leads to lower polyp detection rates, longer procedure times and lower cecal intubation rates. However, there is no consensus about high-quality bowel preparation, so our study evaluated graphical education and appropriate time before elective colonoscopy. Patients and Methods: We performed a secondary analysis of a national colorectal cancer screening programme of 738 patients. The patients were divided into a group given a graphical information manual ( n = 242) or a word-only one ( n = 496). They were also divided into groups according to the interval between bowel preparation and colonoscopy: 6–8 h (Group 1, n = 106), 9–12 h (Group 2, n = 228) and 13–17 h (Group 3, n = 402). All patients were scored according to the Boston Bowel Preparation Scale (BBPS) during the examination. Results: The bowel preparation of the graphical group was significantly better than the text group ( P < 0.001). After adjustment, the bowel preparation score of Group 1 and Group 2 were both significantly higher than that of Group 3 ( P = 0.012 and P = 0.032). Maximum BBPS was 6.31 when the interval time was 6.52 h (95% confidence interval: 5.95–6.66), and when the interval was <10 h, the BBPS was ≥6. Conclusion: High-quality bowel preparation was linked to graphical education and appropriate time before colonoscopy. We suggest that the interval between taking the first laxative and colonoscopy should be <10 h, preferably 6.5 h. Prospective multicentre research is needed to give more evidence of high-quality bowel preparation methods.

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Sex difference in bowel preparation quality and colonoscopy time

Cited by 15 publications

References 43 publications

Factors associated with prolonged cecal insertion time in patients undergoing water exchange colonoscopy

Factors associated with prolonged cecal insertion time in patients undergoing water exchange colonoscopy

The unmet needs for identifying the ideal bowel preparation

Graphical education and appropriate time before elective colonoscopy make better bowel preparation

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