Top

Published in:

05-02-2022 | Abdominal Surgery | Original Article

Colonoscopy Insertion in Patients with Gastrectomy: Does Position Impact Cecal Intubation Time?

Authors: Jae Hyun Kim, Youn Jung Choi, Hye Jung Kwon, Gyu Man Oh, Kyoungwon Jung, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park

Published in: Digestive Diseases and Sciences | Issue 9/2022

Abstract

Background

A history of abdominal surgery is associated with difficulty in colonoscopy insertion. Few studies have reported effective colonoscopy insertion for patients who underwent abdominal surgery due to stomach cancer.

Aim

We aimed to compare the impact of supine position (SP) and left lateral position (LLP) as the starting position of colonoscopy insertion in patients who underwent abdominal surgery due to stomach cancer.

Methods

This was a prospective, randomized controlled trial. Patients undergoing colonoscopy for screening or post-polypectomy surveillance after gastrectomy due to stomach cancer were enrolled and randomized to the SP or LLP group as the starting position of colonoscopy insertion. All colonoscopic examinations were performed with a transparent cap. The primary outcome was to compare the cecal intubation time between the two groups.

Results

A total of 224 patients were enrolled. The mean cecal intubation time was not significantly different between the SP and LLP groups (364.5 s versus 306.9 s; p = 0.105). In patients with a lower body mass index (< 21 kg/m²) or who underwent gastrectomy within three years, the mean cecal intubation time of the LLP group was shorter than the SP group. In the multivariate analysis for the factors affecting to increase in the cecal intubation time (> 5 min), the starting position was not an independent factor.

Conclusion

Either the SP or LLP could serve as a possible starting position of colonoscopy insertion for patients who underwent abdominal surgery due to stomach cancer.

Miller KD, Nogueira L, Mariotto AB et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019;69:363–385. https://doi.org/10.3322/caac.21565.CrossRefPubMed

Jung KW, Won YJ, Hong S et al. Prediction of cancer incidence and mortality in Korea, 2021. Cancer Res Treat 2021;53:316–322. https://doi.org/10.4143/crt.2021.290.CrossRefPubMedPubMedCentral

Gupta S, Cole AP, Marchese M et al. Use of preventive health services among cancer survivors in the U.S. Am J Prev Med 2018;55:830–838. https://doi.org/10.1016/j.amepre.2018.07.021.CrossRefPubMed

Gweon TG, Yoon KT, Kim CH et al. Postgastrectomy gastric cancer patients are at high risk for colorectal neoplasia: a case control study. Intest Res 2021;19:239–246. https://doi.org/10.5217/ir.2020.00009.CrossRefPubMed

Kahi CJ, Boland CR, Dominitz JA et al. Colonoscopy surveillance after colorectal cancer resection: recommendations of the US Multi-Society Task Force on colorectal cancer. Gastroenterology 2016;150:758-768.e711. https://doi.org/10.1053/j.gastro.2016.01.001.CrossRefPubMed

Ghevariya V, Duddempudi S, Ghevariya N et al. Barriers to screening colonoscopy in an urban population: a study to help focus further efforts to attain full compliance. Int J Colorectal Dis 2013;28:1497–1503. https://doi.org/10.1007/s00384-013-1708-7.CrossRefPubMed

Denberg TD, Melhado TV, Coombes JM et al. Predictors of nonadherence to screening colonoscopy. J Gen Intern Med 2005;20:989–995. https://doi.org/10.1111/j.1525-1497.2005.00164.x.CrossRefPubMedPubMedCentral

Clancy C, Burke JP, Chang KH et al. The effect of hysterectomy on colonoscopy completion: a systematic review and meta-analysis. Dis Colon Rectum 2014;57:1317–1323. https://doi.org/10.1097/dcr.0000000000000223.CrossRefPubMed

Kim S, Choi J, Kim TH et al. Effect of previous gastrectomy on the performance of postoperative colonoscopy. J Gastric Cancer 2016;16:167–176. https://doi.org/10.5230/jgc.2016.16.3.167.CrossRefPubMedPubMedCentral

10.

Lee SK, Kim TI, Shin SJ et al. Impact of prior abdominal or pelvic surgery on colonoscopy outcomes. J Clin Gastroenterol 2006;40:711–716. https://doi.org/10.1097/00004836-200609000-00010.CrossRefPubMed

11.

Menzies D, Ellis H. Intestinal obstruction from adhesions—How big is the problem? Ann R Coll Surg Engl 1990;72:60–63.PubMedPubMedCentral

12.

Ergul E, Korukluoglu B. Peritoneal adhesions: facing the enemy. Int J Surg 2008;6:253–260. https://doi.org/10.1016/j.ijsu.2007.05.010.CrossRefPubMed

13.

Zhao S, Yang X, Meng Q et al. Impact of the supine position versus left horizontal position on colonoscopy insertion: a 2-center, randomized controlled trial. Gastrointest Endosc 2019;89:1193-1201.e1191. https://doi.org/10.1016/j.gie.2019.01.009.CrossRefPubMed

14.

East JE, Bassett P, Arebi N et al. Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial. Gastrointest Endosc 2011;73:456–463. https://doi.org/10.1016/j.gie.2010.07.046.CrossRefPubMed

15.

Ball AJ, Johal SS, Riley SA. Position change during colonoscope withdrawal increases polyp and adenoma detection in the right but not in the left side of the colon: results of a randomized controlled trial. Gastrointest Endosc 2015;82:488–494. https://doi.org/10.1016/j.gie.2015.01.035.CrossRefPubMed

16.

Klare P, Huth R, Haller B et al. Patient position and hypoxemia during propofol sedation for colonoscopy: a randomized trial. Endoscopy 2015;47:1159–1166. https://doi.org/10.1055/s-0034-1392329.CrossRefPubMed

17.

Vergis N, McGrath AK, Stoddart CH et al. Right Or Left in COLonoscopy (ROLCOL)? A randomized controlled trial of right- versus left-sided starting position in colonoscopy. Am J Gastroenterol 2015;110:1576–1581. https://doi.org/10.1038/ajg.2015.298.CrossRefPubMed

18.

Uddin FS, Iqbal R, Harford WV et al. Prone positioning of obese patients for colonoscopy results in shortened cecal intubation times: a randomized trial. Dig Dis Sci 2013;58:782–787. https://doi.org/10.1007/s10620-012-2468-x.CrossRefPubMed

19.

Rex DK. How I approach colonoscopy in anatomically difficult colons. Am J Gastroenterol 2020;115:151–154. https://doi.org/10.14309/ajg.0000000000000481.CrossRefPubMed

20.

Zhao SB, Yang X, Fang J et al. Effect of left lateral tilt-down position on cecal intubation time: a 2-center, pragmatic, randomized controlled trial. Gastrointest Endosc 2018;87:852–861. https://doi.org/10.1016/j.gie.2017.11.012.CrossRefPubMed

21.

Kim HH, Park SJ, Park MI et al. Transparent-cap-fitted colonoscopy shows higher performance with cecal intubation time in difficult cases. World J Gastroenterol 2012;18:1953–1958. https://doi.org/10.3748/wjg.v18.i16.1953.CrossRefPubMedPubMedCentral

22.

Koido S, Ohkusa T, Nakae K et al. Factors associated with incomplete colonoscopy at a Japanese academic hospital. World J Gastroenterol 2014;20:6961–6967. https://doi.org/10.3748/wjg.v20.i22.6961.CrossRefPubMedPubMedCentral

23.

Shah HA, Paszat LF, Saskin R et al. Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology 2007;132:2297–2303. https://doi.org/10.1053/j.gastro.2007.03.032.CrossRefPubMed

24.

Anderson JC, Gonzalez JD, Messina CR et al. Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol 2000;95:2784–2787. https://doi.org/10.1111/j.1572-0241.2000.03186.x.CrossRefPubMed

25.

Qureshi A, BiBi S, Madhotra R. Body mass index & low CIR in colonoscopy! Gastroenterol Hepatol Bed Bench 2018;11:125–130.PubMedPubMedCentral

Title: Colonoscopy Insertion in Patients with Gastrectomy: Does Position Impact Cecal Intubation Time?
Authors: Jae Hyun Kim
Youn Jung Choi
Hye Jung Kwon
Gyu Man Oh
Kyoungwon Jung
Sung Eun Kim
Won Moon
Moo In Park
Seun Ja Park
Publication date: 05-02-2022
Publisher: Springer US
Keywords: Abdominal Surgery
Subtotal Gastrectomy
Gastrectomy
Subtotal Gastrectomy
Colonoscopy
Gastrectomy
Published in: Digestive Diseases and Sciences / Issue 9/2022
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-021-07325-3

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Colonoscopy Insertion in Patients with Gastrectomy: Does Position Impact Cecal Intubation Time?

Abstract

Background

Aim

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Aim

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2022

A Novel Decision Aid Improves Quality of Reproductive Decision-Making and Pregnancy Knowledge for Women with Inflammatory Bowel Disease

Using the PIDA on Your PDA: Providing Personalized Education and Decision Support for Women with IBD of Childbearing Age

Distal Biliary Stent Migration in Patients with Irretrievable Bile Duct Stones: Long-Term Comparison Between Straight and Double-Pigtail Stents

Quantification of Interstitial Cells of Cajal in the Gastric Muscle of Patients with Gastroparesis at Per-Oral Endoscopic Pyloromyotomy: A Novel Approach for Future Research in Pathogenesis of Gastroparesis

Relationship Between Body Composition and Death in Patients with COVID-19 Differs Based on the Presence of Gastrointestinal Symptoms

Prevalence of Self-Reported Venous Thromboembolism and Cardiovascular Risk Factors in Patients with Ulcerative Colitis: The GETAID FOCUS Study

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page