title: Not only hysterectomy but also cesarean section can predict incomplete flexible sigmoidoscopy among patients with prior abdominal or pelvic surgery.
abstract: BACKGROUND
  Flexible sigmoidoscopy (FS) is a safe and effective method for colorectal cancer (CRC) screening. Several studies have demonstrated that individuals who have undergone surgery are at a greater risk of having incomplete FS. This study explored predictors of incomplete FS and reduced polyp detection rates for participants who had undergone abdominal or pelvic surgery.
  
  
  METHODS
  From January 2009 to December 2009, individuals participating in health examinations and who had undergone abdominal or pelvic surgery were invited to participate in this investigation. Four experienced gastroenterologists performed examinations using a 60-cm Olympus video sigmoidoscope. Factors associated with incomplete FS insertions and reduced polyp detection rates were analyzed using logistic regression models.
  
  
  RESULTS
  Overall, 106 eligible individuals were analyzed, and 45 (42%) incomplete FS insertions were reviewed. Fifty participants (47%) had undergone pelvic surgery, and the other 56 (53%) had undergone abdominal surgery. Pelvic surgeries were cesarean section (25%) and hysterectomy (15%); appendectomy (36%) was the most common abdominal surgery. The main pathological FS findings were hemorrhoids (54%) and adenomatous polyps (18%). Multivariate analysis indicated that only prior pelvic surgery [odds ratio (OR), 3.54; p = 0.01] was an independent risk factor for incomplete FS insertion. Incomplete examinations were inversely related to adenomatous polyp detection rates (OR, 0.23; p = 0.03).
  
  
  CONCLUSIONS
  Prior pelvic surgery, particularly cesarean section and hysterectomy, is an independent factor for incomplete FS insertion in a selected adult population. In addition, incomplete FS can increase the risk of missing polyps, particularly in individuals who underwent pelvic surgery.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Huay-Min
authors.initials: HM
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan, ROC; Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC.
authors.forename: Hoi-Hung
authors.initials: HH
authors.lastname: Chan
authors.affiliation: Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Mei-Jin
authors.initials: MJ
authors.lastname: Wu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: cklin@vghks.gov.tw.
authors.forename: Chiun-Ku
authors.initials: CK
authors.lastname: Lin
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Hsien-Chung
authors.initials: HC
authors.lastname: Yu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Tsai
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Feng-Woei
authors.initials: FW
authors.lastname: Tsay
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Tzung-Jiun
authors.initials: TJ
authors.lastname: Tsai
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007417:Intestinal Polyps / Q000175:diagnosis*; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery; D011247:Pregnancy; D012812:Sigmoidoscopy
keywords: cesarean section; colorectal cancer; hysterectomy; sigmoidoscopy; surgery