title: The effect of hysterectomy on colonoscopy completion: a systematic review and meta-analysis.
abstract: BACKGROUND
  The primary aim of colonoscopy is a complete and thorough examination of the colon. There are a number of factors, however, that can potentially increase the difficulty of completing a colonoscopy. A significant proportion of women eligible for colorectal cancer screening have undergone hysterectomy. A history of hysterectomy is frequently considered to make colonoscopy more difficult, although there is no consensus in the literature.
  
  
  OBJECTIVE
  The aim of this study is to assess the effect of hysterectomy on colonoscopy completion.
  
  
  METHODS
  A systematic search of PubMed, Embase, and the Cochrane database identified 6 eligible studies.
  
  
  METHODS
  Studies that compared colonoscopy completion rates in women with a previous history of hysterectomy and women with no history of pelvic surgery were selected for review.
  
  
  METHODS
  Meta-analysis was performed by using random-effects methods.
  
  
  METHODS
  The primary outcome used was colonoscopy completion rate. The outcomes were calculated as odds ratio with 95% CI.
  
  
  RESULTS
  A total of 5947 patients were included in the final analysis. The average hysterectomy rate was 26.3% ± 14.5%. The colonoscopy completion rate was significantly reduced in patients with a history of hysterectomy compared with those with no history of pelvic surgery (87.1% vs 95.5%) (OR, 0.28; 95% CI, 0.16-0.49; p < 0.001). Analysis of the funnel plot demonstrated nonsignificant across-study publication bias. There was significant across-study heterogeneity (Cochran Q, 19.6; p = 0.002).
  
  
  CONCLUSIONS
  The endoscopist's experience is poorly defined in some studies. Indication for colonoscopy was not provided in all cases. There is significant across-study heterogeneity.
  
  
  CONCLUSIONS
  Colonoscopy completion rates appear decreased in women with a history of hysterectomy, but the available literature is heterogenous. Further studies in this area are warranted.
authors.affiliation: 1Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland 24i Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Cillian
authors.initials: C
authors.lastname: Clancy
authors.forename: John P
authors.initials: JP
authors.lastname: Burke
authors.forename: Kah Hoong
authors.initials: KH
authors.lastname: Chang
authors.forename: J Calvin
authors.initials: JC
authors.lastname: Coffey
mesh_terms: D003113:Colonoscopy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D017063:Outcome Assessment, Health Care