Factors Affecting the Colonoscopic Cecal Intubation Failure in Patients With Complicated Diverticular Disease of the Colon by a Pericolic Infiltrate

Abstract

Introduction: Cecal intubation rate is an important indicator of colonoscopy quality. But incomplete colonoscopy is higher in patients with chronic, recurrent, complicated colonic diverticular disease due to the risk of complications. We assessed the frequency, factors of the cecal intubation failure in patients with complicated diverticular disease of the colon by a pericolic infiltrate. Methods: Patients operated on for the diverticular disease of the colon complicated by a pericolic infiltrate, confirmed by the morphological study were retrospectively included in the study. Diverticular disease duration was over 6 month with recurrent attacks following treatment. All patients underwent unsedated pre-operative colonoscopy. The parameters studied were age, gender, colonoscopic parameters: complications; cecal intubation rate (CIR); cecal intubation failure rate; external colon compression, narrowing of the lumen and colonic wall edema; tall, thickened, swollen folds of the colon; fixed colonic segments in a limited area; pus; the hemorrhagic component - petechiae, erosions. Results: Thirty-two patients were included (mean age 55,6+12,3 years, M:F = 17:15). All 32 colonoscopic examinations were carried out without complications. We have identified CIR=43,7%, cecal intubation failure rate=56,3%. Analysis of the incidence of the endoscopic imaging parameters showed that the most common signs are the local wall hyperemic area (84,8%) and fixed colonic segments in a limited area (81,2%). The incidence of other endoscopic signs ranged from 31,2% to 56,2%. The comparative analysis revealed that a significant difference in the cecal intubation failure associated only with the external colon compression, narrowing of the lumen and colonic wall edema (Fisher's two-tailed exact test - 0,0092, p < 0,05). Analysis evaluated that the external colon compression, narrowing of the lumen and colonic wall edema is a significant prognostic indicator of the pericolic infiltrate with positive predictive value 100%. Conclusion: Our results show that the external colon compression, narrowing of the lumen and colonic wall edema is valid diagnostic criteria of the pericolic infiltrate in patients with complicated diverticular disease of the colon and at the same time it is the factor affecting the colonoscopic cecal intubation failure in these patients.Figure: External colon compression, narrowing of the lumen and colonic wall edema.Figure: Tall, thickened, swollen folds of the colon.Figure: The hemorrhagic component - petechiae, erosions.