Impact of prior abdominal or pelvic surgery on colonoscopy outcomes.
OBJECTIVE
This large prospective study attempted to analyze the effect of various prior surgery on colonoscopy performance.


BACKGROUND
It is generally presumed that colonoscopy in patients with a history of abdominal or pelvic surgery is difficult. This difficulty is apparently due to adhesions and anatomic alterations after surgery but the incidence, site, and severity of adhesions are different according to the types of surgery.


METHODS
We analyzed completion rate and insertion time in 4089 consecutive colonoscopies in patients with intact colon.


RESULTS
The adjusted completion rate for colonoscopy was 96.7%. The mean insertion time was 6.2+/-4.0 minutes. Not only old age [odds ratio (OR) 1.46; 95% confidence interval (CI) [1.04, 2.04]] and inadequate bowel cleansing (OR 5.82; 95% CI [4.19, 8.09]) but also a surgical history (OR 1.71; 95% CI [1.18, 2.48]) were independent factors associated with procedural incompleteness. Of surgical history, gastrectomy and hysterectomy were significantly associated with procedural incompleteness (P<0.001 and P=0.001, respectively). Old age (OR 1.48; 95% CI [1.22, 1.79]), female sex (OR 1.22; 95% CI [1.01, 1.48]), constipation as an indication (OR 1.58; 95% CI [1.24, 2.02]), and inadequate bowel cleansing (OR 1.46; 95% CI [1.13, 1.88]) were independent factors associated with prolonged insertion time (>10 min), but a surgical history lost statistical power as a predictor for prolonged insertion time in multivariate analysis.


CONCLUSIONS
Although the difference in insertion time was not substantial, a history of abdominal or pelvic surgery is associated with difficulty in colonoscopy.
Lee
Sang Kil
SK
Department of Internal Medicine, Institute of Gastroenterology, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea.
Kim
Tae Il
TI
Shin
Sung Jae
SJ
Kim
Byung Chang
BC
Kim
Won Ho
WH
D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003113:Colonoscopy / Q000379:methods / Q000592:standards*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007440:Intubation; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery; D011446:Prospective Studies; D013997:Time Factors