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Factors Associated with Difficulty Maintaining Insufflation of the Colon During Endoscopy

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An Editorial to this article was published on 27 June 2022

Abstract

Background

Insufflation of the colon allows for adequate visualization of the mucosal tissue and advancement of the endoscope during colonoscopy. Most colonoscopies are performed with sedation to mitigate discomfort and enhance the colonoscopy experience for both the patient and the endoscopist.

Aim

We aimed to evaluate factors associated with difficulty maintaining insufflation.

Methods

A cross-sectional study of individuals undergoing colonoscopy at the Oklahoma City Veterans Affairs Medical Center was performed. Experiencing difficulty maintaining air insufflation during colonoscopy was assessed with a questionnaire completed by the performing endoscopist at the end of procedure. Information regarding procedure times, sedation used, demographics, comorbidities, surgical history, and medications used was extracted from the medical record. A multivariate regression analysis was performed to identify factors associated with difficulty maintaining air insufflation. A P value < 0.05 was considered significant.

Results

996 Patients were included for the analysis. Difficulty with insufflation was reported in 240 (24%) colonoscopies; mean age of 63.8 ± 10.4 years old and 13% were female. Fellow trainees were involved in 669 (67%) colonoscopies. Older age (OR 1.02, P 0.03, CI [1.00–1.04]), diabetes (OR 1.5, 95% CI [1.03, 2.05]), fellow’s involvement (OR 2.6. (95% CI [1.68, 4.09]), total procedure time (OR 1.02, 95% CI [1.00, 1.03]), mean number of adenomas (OR 1.05, 95% CI [1.00, 1.09]), and MAC use (OR 2.6, 95% CI [1.80, 3.85]) were independent predictors for difficulty in maintaining air insufflation.

Conclusion

Our findings suggest that endoscopists should be cognizant of colon insufflation issues in older, diabetic patients undergoing colonoscopies under deep sedation, particularly if prolonged procedure is anticipated or encountered.

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Data availability

Study materials will not be made available.

Abbreviations

CRC:

Colorectal cancer

MAC:

Monitored anesthesia care

ADR:

Adenoma detection rate

BBPS:

Boston Bowel Preparation Scale

VAMC:

Veterans Affairs Medical Center

EMR:

Electronic medical record

COPD:

Chronic obstructive pulmonary disease

BMI:

Body mass index

SD:

Standard deviation

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Funding

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Authors and Affiliations

  1. Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Mohammad F. Madhoun, Ijlal Ali, Thomas J. Corredine & Richard Harty

  2. Veterans Affairs Medical Center, Oklahoma City, OK, USA

    Mohammad F. Madhoun, Ijlal Ali, Thomas J. Corredine & Richard Harty

  3. Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Mohammad F. Madhoun, Nimrah Bader, Ijlal Ali, Bryce Yohannan, Alyssa Grossen, Mahum Nadeem, Thomas J. Corredine & Richard Harty

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  1. Mohammad F. Madhoun
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  2. Nimrah Bader
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  7. Thomas J. Corredine
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Contributions

MFM was involved in study design, statistical analyses, and drafting and final approval of the manuscript; NB was involved in study design, data collection, and drafting the manuscript; IA was involved in data analyses and drafting the manuscript; BY, AG, and MN were involved in data collection; TJC was involved in study design and data collection; RH was involved in critical revision of the article, and final approval. Writing Assistance: none.

Corresponding author

Correspondence to Nimrah Bader.

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Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

The study was approved by the University of Oklahoma Health Sciences Institutional Review Board (IRB), which complies with acceptable international standards (such as the Treaty of Helsinki).

Informed consent

A waiver of informed consent was obtained from the University of Oklahoma Institutional Review Board, as the study was deemed no more than minimal risk, given its retrospective nature.

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An editorial commenting on this article is available at https://doi.org/10.1007/s10620-022-07594-6.

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Madhoun, M.F., Bader, N., Ali, I. et al. Factors Associated with Difficulty Maintaining Insufflation of the Colon During Endoscopy. Dig Dis Sci 68, 202–207 (2023). https://doi.org/10.1007/s10620-022-07592-8

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  • DOI: https://doi.org/10.1007/s10620-022-07592-8

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