title: When and why a colonoscopist should discontinue colonoscopy by himself?
abstract: OBJECTIVE
  To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.
  
  
  METHODS
  In this cross-sectional study, 517 difficult colonoscope insertions (Grade C, Kudo's difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4(th)-level (Kudo's classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient's discomfort or pain, severe colon disease with a perforation risk (e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient's age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time (> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.
  
  
  RESULTS
  Three hundred and twenty-two (62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195 (37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation (OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity (OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation (OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity (OR 0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy (OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex (OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time (> 10 min) was an unfavorable factor for the insertion into the ileocecum.
  
  
  CONCLUSIONS
  Colonoscopy should be discontinued if freedom of the colonoscope body's insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.
authors.affiliation: Tao Gan, Jin-Lin Yang, Jun-Chao Wu, Yi-Ping Wang, Li Yang, Division of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Gan
authors.affiliation: Tao Gan, Jin-Lin Yang, Jun-Chao Wu, Yi-Ping Wang, Li Yang, Division of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jin-Lin
authors.initials: JL
authors.lastname: Yang
authors.affiliation: Tao Gan, Jin-Lin Yang, Jun-Chao Wu, Yi-Ping Wang, Li Yang, Division of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jun-Chao
authors.initials: JC
authors.lastname: Wu
authors.affiliation: Tao Gan, Jin-Lin Yang, Jun-Chao Wu, Yi-Ping Wang, Li Yang, Division of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Wang
authors.affiliation: Tao Gan, Jin-Lin Yang, Jun-Chao Wu, Yi-Ping Wang, Li Yang, Division of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
mesh_terms: D002983:Clinical Competence; D020685:Colonoscopes; D003113:Colonoscopy / Q000009:adverse effects* / Q000295:instrumentation; D003430:Cross-Sectional Studies; D004867:Equipment Design; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Colonoscope insertion; Colonoscopy; Insertion technique