title: Factors affecting the technical difficulty of colonoscopy.
abstract: OBJECTIVE
  Colonoscopy is a standard diagnostic tool for screening and surveillance of diseases affecting the colon. Colonoscopy may be painful for patients and difficult for the endoscopist. The aim of this study was to identify the factors affecting the technical difficulty of a colonoscopic examination and to predict potential difficult patients who will undergo colonoscopy.
  
  
  METHODS
  A total of 646 outpatients were consecutively included in this study. Patient's age and gender, body mass index (BMI), prior surgical history, and the duration and symptoms of irritable bowel syndrome (IBS) were recorded before the procedure. The quality of bowel preparation, the difficulty of examination reported by the colonoscopist, the degree of patient pain, the degree of pain as reported by an observer, cecal intubation time andcolonoscopic findings were assessed after the procedure.
  
  
  RESULTS
  We evaluated the difficulty of colonoscopy by cecal intubation time. Advanced age (>50 years), female gender, low BMI (< or = 23 Kg/m2), poor bowel preparation, prior surgical history, patient pain and the presence of IBS were associated with prolonged cecal intubation time. A multivariate logistic regression analysis demonstrated that advanced age, female gender, low BMI, poor bowel preparation and patient pain were independent factors related to prolonged cecal intubation time.
  
  
  CONCLUSIONS
  In patients with advanced age, female gender and low BMI, information that colonoscopy may be difficult and painful should be provided. If a colonoscopy is not absolutely indicated, barium enema or CT colonography may be performed as alternative diagnostic modalities.
authors: Department of Internal Medicine, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Se Yong
authors: SY
authors: Oh
authors: Chong Il
authors: CI
authors: Sohn
authors: In Kyung
authors: IK
authors: Sung
authors: Dong Il
authors: DI
authors: Park
authors: Mun Su
authors: MS
authors: Kang
authors: Tae Woo
authors: TW
authors: Yoo
authors: Jung Ho
authors: JH
authors: Park
authors: Hong Joo
authors: HJ
authors: Kim
authors: Yong Kyun
authors: YK
authors: Cho
authors: Woo Kyu
authors: WK
authors: Jeon
authors: Byung Ik
authors: BI
authors: Kim
mesh_terms: D003113:Colonoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged