Abstract
ObjectiveThis study aims to determine the factors that prolong cecal intubation time (CIT) and determine the effect of obesity on CIT measured using multiple indexes.MethodsPatients who underwent elective colonoscopy between July 10, 2020, and January 20, 2021, were evaluated in this prospective observational study. Age, gender, constipation, bowel preparation, presence of diverticulosis, previous surgery history, auxiliary maneuver and additional analgesic requirement, cecum intubation length (CL) and obesity indices [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR)] were analyzed. Factors affecting CIT were assessed by both univariate and multivariate logistic regression (LR) analyses.ResultsA total of 512 patients were analyzed. Mean CIT was 5.6 ± 1.6 min, and median CIT was 5.17 min. The CIT median was ≤5.17 min in 264 (51.5%) of the patients, and the CIT median was >5.17 min in 248 (48.5%). In the univariate LR results, young age, constipation, poor bowel preparation, increased CL, additional analgesic requirement, low WHtR, and low BMI (<25 kg/m2) were the factors that prolonged CIT (p <0.05). In the multivariate LR analysis results, WHtR >0.5 and BMI >30 kg/m2 were found to be independent factors that decrease CIT [OR: 0.01 (0.01 0.03) p <0.001; OR: 0.28 (0.13 0.57) p <0.001].ConclusionYounger age, low WHtR, low BMI, increased CL, constipation, inadequate bowel preparation, and the use of extra analgesics were found to be associated with longer CIT. When all factors were evaluated together, obesity measured by only WHtR (>0.5) and BMI (>30 kg/m2) were the best predictors of decreased CIT.
Highlights
Colonoscopy is considered to be the primary screening test for colorectal cancer screening worldwide [1]
This study aims to determine the factors that prolong cecal intubation time (CIT) and determine the effect of obesity indexes measured by body mass index (BMI), waist circumference (WC), and waist-toheight ratio (WHtR) on CIT
No relationship was found between BMI and CIT in the study performed by Hsu et al The authors attributed this to the fact that the pain factor was excluded because the procedures were performed under deep sedation [6]
Summary
Colonoscopy is considered to be the primary screening test for colorectal cancer screening worldwide [1]. Prolongation of cecal intubation time (CIT), which is one of the quality indicators in colonoscopies, decreases adenoma detection rate, causes delay in diagnosis and treatment, and negatively affects patient comfort [2,3]. In a systematic review and meta-analysis conducted in 2018, factors affecting CIT were examined, and it was reported that elderly patients, female gender, low body mass index (BMI), and poor bowel preparation prolonged CIT [4]. In a limited number of studies, the effects of obesity indices such as BMI, waist circumference, and visceral and subcutaneous adipose tissue on CIT have been investigated, and CIT is shorter in overweight patients [7,8,9]. A recent study showed that WHtR is more predictive than BMI in estimating visceral fat ratio [11]
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