How Important Is Abdominal Compression and Position Change in Successful Colonoscopy to the Cecum?

Abstract

Purpose: To determine the utility of abdominal compression and position change in successful colonoscopy to the cecum. Methods: 268 consecutive patients undergoing elective colonoscopy at an ambulatory endoscopy center were enrolled in the study. Patients having undergone previous colon resections were excluded. Olympus video colonoscopes were used for all procedures. All patients were sedated with diprovan. A stopwatch was used to determine the time from introduction of the colonoscope to cecal intubation. All exams were performed by one endoscopist (apk). Regions of abdominal compression were divided into Right Upper Quadrant (RUQ), Left Upper Quadrant (LUQ), Right Lower Quadrant (RLQ), and Left Lower Quadrant (LLQ). Position changed referred to transferring the patient from left lateral decubitus to any other position. Results: The 268 patients enrolled in the study included 130 males (48.5%) and 138 females (51.5%). Mean study participant age was 62 yrs. 266 out of 268 (99%) exams were successsful. Identification of the ileocecal valve confirmed all successful exams. The mean time to cecal intubation in successful exams was 3 min 13 sec (range 1min 3sec to 18 min 37sec). The 2 unsuccessful exams involved 1 unsuccessful sigmoid traversal and 1 unsuccessful hepatic flexure passage. Mean withdrawal time for all successful exams was 12 min 3 sec (range 2 mins 36 sec to 39 mins. Abdominal compression was necessary in 55 out of 268 patients (20.52%). In those patients requiring abdominal compression the RUQ was the most frequent area compressed (25pts. 45%). The frequency for compression of other regions was as follows. LLQ 10pts (18%) RUQ & LLQ 8pts (15%) LUQ 6 pts (11%) ALL 4 quadrants 3pts (5%) RUQ & LUQ 1pt (2%) RUQ, LLQ, RLQ 1pt (2%) LLQ&LUQ 1pt (2%) No patient warranted position change from the LLQ position to achieve cecal intubation. Conclusions: Abdominal compression to achieve cecal intubation is necessary in the minority of patients undergoing outpatient colonoscopy. Assisting the colonoscope around the hepatic flexure with gentle RUQ compression appears to be the most useful compressive maneuver in achieving cecal intubation. Performing routine sigmoid compression at the initiation of all colonoscopic exams is not warranted. Position change was not necessary in this study to achieve cecal intubation. Colonoscopy to the cecum can be successful in a high percentage of patients in the private practice setting.