Factors predictive of difficult colonoscopy

Background: Prediction of a technically difficult colonoscopy may influence patient selection and procedure scheduling. Identification of predictive f actors may be difficult because a common endpoint used to evaluate the succ ess of colonoscopy is intubation of the cecum, which is usually achieved. T he goal of this study was to examine the feasibility of using an alternativ e measure, time required for cecal intubation, to identify factors that can impact performance of colonoscopy. Methods: The time required for cecal intubation was prospectively recorded for 802 consecutive outpatient colonoscopies performed by 7 experienced gas troenterologists. Patient data collected included height, weight, age, bowe l habits, surgical history, and findings at colonoscopy. Fortyseven examina tions that were stopped because of disease or unacceptable bowel preparatio n were excluded. The impact of the patient characteristics of the remaining sample of 755 patients on the median time required for cecal intubation fo r men and women was examined. Results: Older age and female gender, body mass index less than or equal to 25.0 (regardless of gender), diverticular disease in women, and a history of constipation or reported laxative use in men were predictors of difficul t colonoscopy. Conclusions: By using median time required for cecal intubation, several pa tient characteristics were identified that may predict technical difficulty at colonoscopy. These findings have implications for practice and teaching .