Elsevier

Gastrointestinal Endoscopy

Volume 52, Issue 5, November 2000, Pages 600-605
Gastrointestinal Endoscopy

Original Articles
Factors affecting insertion time and patient discomfort during colonoscopy,☆☆

Presented as abstract and poster at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 16-19, 1999, Orlando, Florida (Gastrointest Endosc 1999;49:60).
https://doi.org/10.1067/mge.2000.109802Get rights and content

Abstract

Background: Successful colonoscopy depends on insertion of the instrument to the cecum, precise observation, and minimal patient discomfort during the procedure. The aim of this prospective study was to determine whether certain variables are associated with insertion time and patient discomfort during colonoscopy. Methods: Nine hundred nine consecutive colonoscopic examinations performed by a single endoscopist in patients without obstructive disease of the colorectum were analyzed. Four liters of Colonlyte (Taejun, Seoul, Korea) were used for bowel cleansing, and meperidine (25 mg) was administered intramuscularly 10 minutes before the procedure. The degree of patient discomfort was assessed using a 5-level Likert scale. Results: Among 909 study patients, colonoscopy was completed to the cecum in 876 patients (96.4%). The adjusted completion rate was 98% and mean insertion time for complete colonoscopy was 6.9 ± 4.2 minutes. Colonoscopy caused less patient discomfort than barium enema or esophagogastroduodenoscopy. Multivariate logistic regression analysis demonstrated that inadequate bowel cleansing, advanced age, and constipation as an indication are independent factors associated with prolonged insertion time (> 10 minutes). Female gender was the only independent factor associated with significant discomfort (≥ level 4) during colonoscopy. Conclusions: Among the factors affecting insertion time and patient discomfort during colonoscopy, unsatisfactory bowel preparation was the only correctable factor. (Gastrointest Endosc 2000;52:600-5.)

Section snippets

Patients and methods

Between April 1998 and March 1999, there were 991 colonoscopic examinations performed by a single endoscopist (W.H.K.) using a video colonoscope (CF 200I or CF 200L; Olympus Optical Co. Ltd., Tokyo, Japan). Eighty-two patients with obstructive disease of the colon or rectum were excluded from the analysis. Among 909 study patients who completed a questionnaire, colonoscopy could not be performed to the cecum in 33 cases (3.6%). A total of 876 patients who underwent complete colonoscopy—465 men

Indications for colonoscopy

Change in bowel habit, including diarrhea and constipation, was the most common indication (33.2%) for colonoscopy, followed by diagnosis and follow-up of neoplastic diseases (32.2%), abdominal pain (23.0%), thin stool caliber (18.9%), hematochezia (15.3%), screening (10.4%), inflammatory bowel disease (9.8%), tenesmus (9.0%), and family history of colonic disease (3.1%).

Completion rate and reasons for non-completion

Among 991 patients who underwent colonoscopy, 82 patients had obstructive diseases of the colon or rectum. Complete

Discussion

Most physicians and patients have a bias that colonoscopy is an invasive procedure that is always painful and distressing. Therefore, colonoscopy causes significant anxiety, not only for patients undergoing the procedure, but also for referring physicians. Indeed, some patients may experience substantial discomfort, but others may not. However, there is limited information as to how distressing this procedure is and the variables that relate to significant discomfort during the procedure.

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  • Cited by (199)

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    Reprint requests: Won Ho Kim, MD, Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, Seoul, 120-752, Korea; fax (82)-2-393-6684; e-mail: [email protected].

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    Gastrointest Endosc 2000;52:600-5.

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