Correlation between obesity and metabolic syndrome-related factors and cecal intubation time during colonoscopy

Investigation of the relationship between colonoscopy insertion difficulty factors and endoscope shape using an endoscopic position detection unit

In this study, we investigated the relationship between the cecal intubation time (CIT) and the form and method used for passing through the sigmoid/descending colon junction (SDJ) and the hepatic flexure using an endoscopic position detection unit (UPD), with reference to various factors [age, sex, body mass index (BMI), history of abdominal and pelvic surgery, and diverticulum]. A total of 152 patients underwent colonoscopy with UPD. The mean age was 66.9 ± 12.4 years, and the male to female ratio was 3.6:1. The average CIT time was 14.3 ± 8.2 min. Age, number of experienced endoscopies, history of abdominal and pelvic surgery, BMI, and diverticulum were associated with prolonged CIT; SDJ passage pattern was straight: 8.6 ± 5.0, alpha loop: 11.8 ± 5.6, puzzle ring-like loop: 20.2 ± 5.0, reverse alpha loop: 22.4 ± 9.7, and other loop: 24.7 ± 10.5. The hepatic flexure passing method was in the following order: right rotation maneuver: 12.6 ± 6.6, push maneuver: 15.1 ± 5.9, and right rotation with positional change maneuver: 20.5 ± 7.2. In conclusion, colonoscopy with UPD revealed an association between CIT and SDJ passage pattern and hepatic flexure passing method.

Factors affecting cecal intubation time during colonoscopy

In recent years, the morbidity and mortality of colorectal cancer (CRC) have increased significantly in China, and it has become one of the major malignancies that threaten the health of residents. Colonoscopy is the gold standard for the diagnosis of CRC. High-quality colonoscopy can effectively reduce the mortality of CRC. Cecal intubation time (CIT) is one of the indicators to reflect the quality of colonoscopy. Studies have found that many factors can affect CIT. This paper reviews the literature to identify the factors that affect CIT, such as those related to doctors, patients, assistive technologies, and equipment, in order to improve the quality of colonoscopy performed by endoscopists.

Cecal intubation time in screening colonoscopy

The time required to intubate the cecum varies. The aim of this study was to determine whether demographic and anthropometric factors, such as body mass index (BMI), percent body fat, muscle mass, and fat mass, affect the cecal intubation time (CIT) during complete colonoscopy.A retrospective chart review of 1229 patients (aged 40-80 years) was performed. These patients underwent average-risk screening colonoscopies performed by expert gastroenterologists at Health Check-up Center, Seoul National University Bundang Hospital, during a health check-up. We collected data on age, sex, BMI, percent body fat, muscle mass, fat mass, history of prior abdominal or pelvic surgery, CIT, and bowel preparation quality (Boston Bowel Preparation Scale [BBPS] score).Of the 1229 patients, 62% were men. The mean age was 55 years, and the mean BMI was 24 kg/m2. The median CIT was 5 min. The patients were categorized into two groups according to CIT: easy colonoscopy (CIT ≤ 10 min) and difficult colonoscopy (CIT > 10 min). In univariate analysis, CIT was prolonged by the following factors: older age, poor bowel preparation, lower BMI, lower percent body fat, and less fat mass. Multivariate analysis showed that anthropometric indices including BMI, percent body fat, muscle mass, and fat mass were not significant factors for CIT. Older age (≥ 70 years) (odds ratio [OR]: 2.272, 95% confidence interval [CI]: 1.056-4.890, P = .036) and poor bowel preparation (BBPS score ≤ 5) (OR: 3.817, 95% CI: 1.866-7.808, P = .000) were found to be correlated with difficult colonoscopy.Our study suggests that anthropometric indices including BMI, percent body fat, muscle mass, and fat mass are not associated with significantly different CIT. Furthermore, sex and prior abdominal or pelvic surgery are not useful factors for a prolonged CIT. Older age (≥ 70 years) and poor bowel preparation (BBPS score ≤ 5) are significant variables predicting the CIT of expert gastroenterologists.

Effect of tartary buckwheat, rutin, and quercetin on lipid metabolism in rats during high dietary fat intake

Tartary buckwheat is rich in flavonoids. However, the health-promoting effect of these flavonoids has not been adequately studied. In the present study, we investigated the impact of rutin, quercetin, and Tartary buckwheat on the lipid metabolism of rats on a high-fat diet. Quercetin could significantly reduce body weight, serum triacylglycerol, low-density lipoprotein cholesterol, TNF-α, insulin, and ameliorate glucose tolerance. It was surprising that Tartary buckwheat significantly increased the weight of the rats. Rutin, quercetin, and Tartary buckwheat tended to decreased fat deposition in the liver of rats but have little effect on short-chain fatty acid production. The changes in the structure and diversity of the microbiota were found to be modulated by these diets. It was concluded that quercetin could attenuate high-fat diet-induced obesity, rutin, quercetin, and Tartary buckwheat can shape the specific structure of gut microbiota. Mechanism of Tartary buckwheat on lipid metabolism needs further systematic research.

Factors for cecal intubation time during colonoscopy in women: Impact of surgical history

BACKGROUND/AIM

Cecal intubation during colonoscopy is prone to be prolonged in women, which may be related to frequent exposure to pelvic/abdominal surgery. We evaluated the association between Cecal Intubation Time (CIT) and prior episodes of pelvic/abdominal surgery in women.

PATIENTS AND METHODS

A cross-sectional study was conducted on screening participants who underwent colonoscopy. Multivariate regression with parameter estimates (β) was performed to determine the factors affecting CIT, including age, body mass index (BMI), bowel preparation, sedation, diverticulosis, experience of colonoscopists, and a surgical history. Also, subgroup analyses according to type of surgery were performed.

RESULTS

A total of 835 women were enrolled. The mean CIT was 5.82 ± 3.40 min. 323 females (38.7%) had episodes of surgery. The CIT was prolonged in cases performed by non-experienced trainees (β = 3.61, P< 0.001) and with a history of gynecological surgery (β = 0.97, P = 0.001). In the subgroup of non-experienced trainees, lower BMI, poor preparation, and a history of cesarean section significantly prolonged the CIT. Also, the risk for difficult colonoscopy (CIT ≥ 15 min) was increased with a history of cesarean section (odds ratio = 4.43, P= 0.024).

CONCLUSION

A prior episode of gynecological surgery prolonged CIT. Also, cesarean section history was associated with difficult colonoscopy in the examination by non-experienced trainees.

Impact of bowel preparation on caecal intubation time during colonoscopy

Objective

To determine the caecal intubation time depending on bowel preparation as per Boston Bowel Preparation Scale.

Methods

This cross-sectional study was conducted at Dr. Ruth K. M. Pfau, Civil Hospital Karachi between August 2018 to February 2019. A total of 201 patients were included in the study. Time was recorded from insertion of colonoscope to the time required to reach the cecum. Bowel preparation was graded during withdrawal of colonoscope by using Boston Bowel Preparation Scale. Pearson Correlation test was used to study correlation of BBPS scores with CIT, gender, BMI, adenoma and polyp detection.

Results

In this study 201 patients undergoing colonoscopy were included. Mean ±SD of age of patients was 36.9 ±15.8 years. Out of the 201 patients 112 (56%) were males and 89 (44%) were females. The results of our study showed that increased Boston Bowel Preparation Scale Scores were associated with decreased caecal intubation time. The mean CIT was 10.7 ±5.4 minutes and Pearson correlation was significant at 0.002. Significant correlations of BBPS were also found with BMI and adenoma detection.

Conclusion

The diagnostic effectiveness of colonoscopy depends upon the quality of the preparation. Good bowel preparation improves the speed of colonoscopy and its completeness.

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

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.