Post written by Alexander Miller, MD, from Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA, and Joseph C. Anderson, MD, from the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, White River Junction VA Medical Center, White River Junction, Vermont, USA, and New Hampshire Colonoscopy Registry, Lebanon.

We explored the association between patient, endoscopist, and examination factors and cecal intubation rates in colonoscopies performed throughout the state of New Hampshire using a large, recent data set.

Complete evaluation of the colonic mucosa is critical for detecting all adenomas and sessile serrated polyps/lesions, allowing for resection of these polyps and prevention of colorectal cancer. Studies have illustrated that patient factors, such as female sex and body mass index (BMI), can be associated with lower cecal intubation rates, potentially increasing their risk for postcolonoscopy colorectal cancer.

Thus, we felt it is important to further clarify how these factors are influencing completion rates in current practice to maximize effectiveness of screening. As colonoscopy is an operator-dependent procedure, we also compared the association between endoscopist factors and cecal intubation rates. To ensure the entire colonic mucosa is evaluated and to better understand challenges in cecal intubation in patients with these factors, we looked at how these factors influenced the anatomical location where the examination was halted. 

We observed that completion rates are improving in New Hampshire. However, our data demonstrated that male patients still have a roughly 50% greater chance of cecal intubation than female patients, even when correcting for other patient and examination factors.

We also noted that advanced age and low or high BMI still negatively affect cecal intubation rates. Moreover, our data indicated that having a gastroenterologist perform the examination and having an endoscopist with an adenoma detection rate >25% and propofol sedation were associated with a significantly higher chance of cecal intubation.

In addition, we confirmed a study from nearly 25 years ago (Anderson et al)¹ by showing that male patients and those with a BMI ≥30 were more likely to have an examination terminated in the right-sided colon versus the left-sided colon, and incomplete examinations in women were more likely to be halted in the left-sided colon.

These data support the concept that men are more likely to have redundant colons, whereas women are more likely to have severe angulation in the distal colon. Endoscopists should recognize these potential challenges when performing colonoscopies.

Future studies could review strategies aimed at these potential challenges that could include use of water immersion and an adult colonoscope in men while considering use of the thinner pediatric scope for female patients.

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1. Anderson JC, Gonzalez JD, Messina CR, Pollack BJ. Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol 2000;95:2784-7. ↩︎