Impact of Anatomic Factors and Prior Abdominal or Pelvic Surgery on Colonoscopy Outcomes

Abstract

OBJECTIVE: To evaluate the anatomic factors and the impact of previous abdomino-pelvic surgeries on incomplete lower gastrointestinal endoscopies in Central Universitary Emergency Military Hospital from Bucharest, between 2015-2019. BACKGROUND: Some studies has shown that colonoscopies are more challenging and request more time and patience, when are performed on patients with a surgical history. We conclude that the anatomic structures from abdomen and pelvis suffer some changes like scars and adhesions after major surgeries. METHODS: We study the cecal intubation rate on a total of 788 colonoscopies on patients with intact or previous surgery on the colon. RESULTS: Our study include 2 groups, one with complete procedures (cecal intubation), and one with incomplete procedures and we found differences, regarding - female sex ( 232 men and 206 women vs 93 men and 257 women; p<0,001), age > 60 years old , a history of prior abdominal or pelvic surgery (total hysterectomy, anexectomy, and post-colon adenocarcinoma resections; p<0,001), patients who were at the first colonoscopy vs patients at check-up; p<0,001, rectal and sigmoidian loops formation. No statistical relevance was observed regarding the operator (senior specialist vs specialist physician, p<0,005), and there was no correlation between the patient’s BMI (body mass index) vs cecal intubation; p=0,587. CONCLUSION: We found that some factors and pathologies had an impact on incomplete colonoscopies. The most important ones are the loops formations, colonic diverticulosis, and the patient surgical history who disturbed the normal anatomy and made the colonoscopy more difficult.