title: Difficult colonoscopy score identifies the difficult patients undergoing unsedated colonoscopy.
abstract: BACKGROUND
  Many factors have been found to affect the difficulty of colonoscope insertion, such as age, gender, body mass index (BMI), history of abdominal surgery and operator etc. However, a scoring system may be more useful to predict the difficulty during colonoscopy.
  
  
  METHODS
  The individual and procedure-related data of 616 patients undergoing colonoscopy were prospectively collected from December 2013 through February 2014 in Xijing Hospital of Digestive Diseases. Cox regression analysis was used to identify high-risk factors associated with difficulty of colonoscopy. A predicting model with the difficult colonoscopy score (DCS) was developed.
  
  
  RESULTS
  Total cecum intubation rate was 98.9% (609/616). Advanced age, lower BMI, inexperienced operator and fair or poor sleep quality were identified as independent factors of prolonged insertion time (all p < 0.05), which were used to develop the DCS. Based on the score, patients could be divided into high-risk and low-risk groups with distinct incomplete rates within 10 min (42.0% vs. 16.5%, p < 0.001). Compared with those with DCS ≤ 1, patients with DCS > 1 had increased insertion time (10.6 ± 0.7 min vs. 6.9 ± 0.2 min, p < 0.001) and pain score (1.9 ± 1.5 vs. 1.4 ± 1.4, p = 0.002). More abdominal compression (36.9% vs. 16.8%, p < 0.001) and position change (51.4% vs. 22.6%, p < 0.001) were needed in this group of patients.
  
  
  CONCLUSIONS
  Patients with DCS > 1 had longer insertion time, higher pain score and needed more abdominal compression and position changes. DCS was useful for predicting the difficulty of colonoscope intubation. (ClinicalTrials.gov NCT02105025 05/05/2014).
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. jiahuiv@gmial.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Jia
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. 13310983711@163.com.|Shannxi Second People's Hospital, Xian, China. 13310983711@163.com.
authors.forename: Limei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. fmmulh@163.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Luo
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. 1013687099@qq.com.
authors.forename: Shaowei
authors.initials: S
authors.lastname: Yao
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. windxp2013@163.com.
authors.forename: Xiangping
authors.initials: X
authors.lastname: Wang
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. 83169397@qq.com.
authors.forename: Linhui
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. 120723988@qq.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Huang
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. bless_ok@126.com.
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. kangxiaoyu@hotmail.com.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Kang
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. panyanglin@gmail.com.
authors.forename: Yanglin
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. xuegangguo@gmail.com.
authors.forename: Xuegang
authors.initials: X
authors.lastname: Guo
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D002432:Cecum; D002983:Clinical Competence; D003113:Colonoscopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012737:Sex Factors; D012890:Sleep; D012907:Smoking; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives