Skip to main content
SpringerLink
Log in

Risk factors associated with longer cecal intubation time: a systematic review and meta-analysis

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Cecal intubation time (CIT) is an indicator for difficult colonoscopy which is associated with patients’ unpleasant experience as well as increased risk of complications. Several studies have attempted to identify predictors for prolonged CIT but those studies tended to be small which gave rise to inconsistent and underpowered results. This systematic review and meta-analysis was conducted to summarize all available data.

Methods

MEDLINE and EMBASE databases were searched through November 2017 for studies that investigated the factors for prolonged CIT. Only factors that were reported by at least three studies were included in the meta-analyses. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated using random effects model. The between-study heterogeneity of effect size was quantified using the Q statistic and I2.

Results

A total of nine studies involving 7131 patients were included. A total of six factors were analyzed. Patients with older age (≥ 65 versus < 65), female sex (versus male), low body mass index (BMI) (< 25 versus ≥ 25 kg/m2), and poor bowel preparation (versus fair to good) had significantly longer CIT. The presence of diverticulosis and prior abdominal surgery were not significantly associated with prolonged CIT.

Conclusions

The current meta-analyses have demonstrated that old age, female sex, low BMI, and poor bowel preparation were the predictors for prolonged CIT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108

    Article  PubMed  Google Scholar 

  2. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F (2017) Global patterns and trends in colorectal cancer incidence and mortality. Gut 66:683–691

    Article  PubMed  Google Scholar 

  3. Center MM, Jemal A, Smith RA, Ward E (2009) Worldwide variations in colorectal cancer. CA Cancer J Clin 59:366–378

    Article  PubMed  Google Scholar 

  4. Brenner H, Chang-Claude J, Rickert A, Seiler CM, Hoffmeister M (2012) Risk of colorectal cancer after detection and removal of adenomas at colonoscopy: population-based case-control study. J Clin Oncol 30:2969–2976

    Article  PubMed  Google Scholar 

  5. Pan J, Xin L, Ma YF, Hu LH, Li ZS (2016) Colonoscopy reduces colorectal cancer incidence and mortality in patients with non-malignant findings: a meta-analysis. Am J Gastroenterol 111:355–365

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schoenfeld PS, Cohen J (2013) Quality indicators for colorectal cancer screening for colonoscopy. Tech Gastrointest Endosc 15:59–68

    Article  PubMed  PubMed Central  Google Scholar 

  7. Anderson JC, Messina CR, Cohn W, Gottfried E, Ingber S, Bernstein G, Coman E, Polito J (2001) Factors predictive of difficult colonoscopy. Gastrointest Endosc 54:558–562

    Article  CAS  PubMed  Google Scholar 

  8. von Renteln D, Robertson DJ, Bensen S, Pohl H (2017) Prolonged cecal insertion time is associated with decreased adenoma detection. Gastrointest Endosc 85:574–580

    Article  Google Scholar 

  9. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL (2006) Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 355:2533–2541

    Article  CAS  PubMed  Google Scholar 

  10. Anderson JC, Gonzalez JD, Messina CR, Pollack BJ (2000) Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol 95:2784–2787

    Article  CAS  PubMed  Google Scholar 

  11. Bernstein C, Thorn M, Monsees K, Spell R, O’Connor JB (2005) A prospective study of factors that determine cecal intubation time at colonoscopy. Gastrointest Endosc 61:72–75

    Article  PubMed  Google Scholar 

  12. Hsieh Y-H, Kuo C-S, Tseng K-C, Lin H-J (2008) Factors that predict cecal insertion time during sedated colonoscopy: the role of waist circumference. J Gastroenterol Hepatol 23:215–217

    Article  PubMed  Google Scholar 

  13. Kawasato R, Hashimoto S, Shirasawa T, Goto A, Okamoto T, Nishikawa J, Sakaida I (2017) Correlation between obesity and metabolic syndrome-related factors and cecal intubation time during colonoscopy. Clin Exp Gastroenterol:10:1–10:7

  14. Krishnan P, Sofi AA, Dempsey R, Alaradi O, Nawras A (2012) Body mass index predicts cecal insertion time: the higher, the better. Dig Endosc 24:439–442

    Article  PubMed  Google Scholar 

  15. Liang C-M, Chiu Y-C, Wu K-L, Tam W, Tai W-C, Hu M-L, Chou Y-P, Chiu KW, Chuah SK (2012) Impact factors for difficult cecal intubation during colonoscopy. Surg Laparosc Endosc Percutan Tech 22:443–446

    Article  PubMed  Google Scholar 

  16. Nagata N, Sakamoto K, Arai T, Niikura R, Shimbo T, Shinozaki M, Noda M, Uemura N (2014) Predictors for cecal insertion time: the impact of abdominal visceral fat measured by computed tomography. Dis Colon Rectum 57:1213–1219

    Article  PubMed  Google Scholar 

  17. Park H-J, Hong J-H, Kim H-S, Kim B-R, Park S-Y, Jo K-W, Kim J-W (2013) Predictive factors affecting cecal intubation failure in colonoscopy trainees. BMC Med Educ 13:5

    Article  PubMed  PubMed Central  Google Scholar 

  18. Uddin FS, Iqbal R, Harford WV, Dunbar KB, Cryer BL, Spechler SJ, Feagins LA (2013) Prone positioning of obese patients for colonoscopy results in shortened cecal intubation times: a randomized trial. Dig Dis Sci 58:782–787

    Article  PubMed  Google Scholar 

  19. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54:1046–1055

    Article  CAS  PubMed  Google Scholar 

  21. Akere A, Otegbayo JA (2016) Complete colonoscopy: impact of patients’ demographics and anthropometry on caecal intubation time. BMJ Open Gastroenterol 3:e000076

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jain D, Goyal A, Uribe J (2016) Obesity and Cecal intubation time. Clin Endosc 49:187–190

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee HL, Eun CS, Lee OY, Jeon YC, Han DS, Sohn JH, Yoon BC, Choi HS, Hahm JS, Lee MH, Lee DH, Moon W, Kim SY (2009) Significance of colonoscope length in cecal insertion time. Gastrointest Endosc 69:503–508

    Article  PubMed  Google Scholar 

  24. Poniewierka E, Dudkowiak R, Marczynski W (2016) Impact of sex and body mass index on cecal intubation time. Is it a myth that colonoscopy is easier to perform in obese than lean people? J Med Sci 85:298–301

    Article  Google Scholar 

  25. Khashab MA, Pickhardt PJ, Kim DH, Rex DK (2009) Colorectal anatomy in adults at computed tomography colonography: normal distribution and the effect of age, sex, and body mass index. Endoscopy 41:674–678

    Article  CAS  PubMed  Google Scholar 

  26. Sadahiro S, Ohmura T, Yamada Y, Saito T, Taki Y (1992) Analysis of length and surface area of each segment of the large intestine according to age, sex and physique. Surg Radiol Anat 14:251–257

    Article  CAS  PubMed  Google Scholar 

  27. Waye JD (2013) Difficult colonoscopy. Gastroenterol Hepatol (N Y) 9:676–678

    Google Scholar 

  28. Streett SE (2007) Endoscopic colorectal cancer screening in women: can we do better? Gastrointest Endosc 65:1047–1049

    Article  PubMed  Google Scholar 

  29. Saunders BP, Fukumoto M, Halligan S, Jobling C, Moussa ME, Bartram CI, Williams CB (1996) Why is colonoscopy more difficult in women? Gastrointest Endosc 43:124–126

    Article  CAS  PubMed  Google Scholar 

  30. Rowland RS, Bell GD, Dogramadzi S, Allen C (1999) Colonoscopy aided by magnetic 3D imaging: is the technique sufficiently sensitive to detect differences between men and women? Med Biol Eng Comput 37:673–679

    Article  CAS  PubMed  Google Scholar 

  31. Geer EB, Shen W (2009) Gender differences in insulin resistance, body composition, and energy balance. Gend Med 6(Suppl 1):60–75

    Article  PubMed  PubMed Central  Google Scholar 

  32. Witte TN, Enns R (2007) The difficult colonoscopy. Can J Gastroenterol 21:487–490

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yoong KK, Heymann T (2005) Colonoscopy in the very old: why bother? Postgrad Med J 81:196–197

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Lee SK, Kim TI, Shin SJ, Kim BC, Kim WH (2006) Impact of prior abdominal or pelvic surgery on colonoscopy outcomes. J Clin Gastroenterol 40:711–716

    Article  PubMed  Google Scholar 

  35. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJS, O’Brien F, Buchan S, Crowe AM (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480

    Article  CAS  PubMed  Google Scholar 

  36. Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM, the Surgical and Clinical Adhesions Research (SCAR) Group (2005) The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Color Dis 7:551–558

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA

    Veeravich Jaruvongvanich & Tomoki Sempokuya

  2. Division of Internal Medicine, Texas Tech University, Lubbock, TX, 96817, USA

    Passisd Laoveeravat

  3. Division of Clinical Epidemiology, Siriraj Medical Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Patompong Ungprasert

Authors
  1. Veeravich Jaruvongvanich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomoki Sempokuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Passisd Laoveeravat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patompong Ungprasert
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VJ conceived of the study, searched the literature, extracted the data, and drafted the manuscript. PU searched the literature, performed the statistical analysis, and drafted the manuscript. TS and PL extracted the data, assessed the quality of the studies, and drafted the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Veeravich Jaruvongvanich.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No informed consent.

Disclosure statement

The authors have nothing to disclose

Electronic supplementary material

ESM S1

Search strategy (DOCX 15 kb)

Supplementary Fig 1

(JPEG 271 kb)

Supplementary Fig 2

(JPEG 240 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jaruvongvanich, V., Sempokuya, T., Laoveeravat, P. et al. Risk factors associated with longer cecal intubation time: a systematic review and meta-analysis. Int J Colorectal Dis 33, 359–365 (2018). https://doi.org/10.1007/s00384-018-3014-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-018-3014-x

Keywords

Search

Navigation