PDF herunterladen
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E311-E320
DOI: 10.1055/a-1672-3525
Original article

Efficacy and tolerability of colonoscopies in overweight and obese patients: Results from a national database on gastrointestinal endoscopic outcomes

Monica Passi 
Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
,
Farial Rahman
Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
,
Christopher Koh
Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
,
Sheila Kumar
Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Background and study aims Gastroenterologists are encountering a rising number of obese patients requiring colonoscopy. Existing literature regarding colonoscopy outcomes in this population is scant and conflicting. We analyzed a nationwide cohort of patients to identify the effects of body mass index (BMI) on colonoscopy success, efficacy, and tolerability.

Patients and methods The Clinical Outcomes Research Initiative (CORI) endoscopic database was queried for all colonoscopies in adults between 2008–2014. Patients were stratified into four cohorts based on BMI classification for comparison. Multivariable analysis was performed to identify the effect of BMI on procedure outcome, efficacy and tolerability.

Results Of 41,401 procedures, 27,696 met study inclusion criteria. Of these, 49.4 % were performed for colorectal cancer screening, most commonly under anesthesia directed sedation. Patient discomfort was the reason for an incomplete colonoscopy in 18.7 % of all cases, and more frequent among the overweight and obese cohorts. An inadequate bowel preparation was most common in the class III obesity cohort. Compared to the normal BMI group, a BMI ≥ 30 and < 40 kg/m2 was associated with an increased odds of an incomplete colonoscopy (P = 0.001for overweight, P = 0.0004 for class I/II obesity), longer procedure (P < 0.05 for all) and poorer tolerance (P < 0.0001 for class I/II obesity, P = 0.016 for class III obesity). Anesthesia-administered sedation was more commonly used than endoscopist directed sedation amongst the obese cohort compared with the normal BMI cohort (P < 0.0001).

Conclusions Endoscopists should consider the increased odds of incomplete colonoscopy, longer procedures, and poorer tolerance when performing colonoscopy in obese patients to improve clinical management and procedural outcome.

Supplementary material



Publikationsverlauf

Eingereicht: 26. Januar 2021

Angenommen: 17. September 2021

Artikel online veröffentlicht:
14. April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Seibert RG, Hanchate AD, Berz JP. et al. National disparities in colorectal cancer screening among obese adults. Am J Prev Med 2017; 53: e41-e49
    CrossrefPubMedGoogle Scholar
  • 2 Vargo JJ. Procedural sedation and obesity: waters left uncharted. Gastrointest Endosc 2009; 70: 980-984
    CrossrefPubMedGoogle Scholar
  • 3 Sharma R. An examination of colorectal cancer burden by socioeconomic status: evidence from GLOBOCAN 2018. EPMA J 2020; 11: 95-117
    CrossrefPubMedGoogle Scholar
  • 4 Moore LL, Bradlee ML, Singer MR. et al. BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int J Obes Relat Metab Disord 2004; 28: 559-567
    CrossrefPubMedGoogle Scholar
  • 5 Lucendo AJ. Colonoscopy in obese patients: time to change position. Dig Dis Sci 2013; 58: 608-609
    CrossrefPubMedGoogle Scholar
  • 6 Wong MC, Chan CH, Cheung W. et al. Association between investigator-measured body-mass index and colorectal adenoma: a systematic review and meta-analysis of 168,201 subjects. Eur J Epidemiol 2018; 33: 15-26
    CrossrefPubMedGoogle Scholar
  • 7 Ferlay J, Colombet M, Soerjomataram I. et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019; 144: 1941-1953
    CrossrefPubMedGoogle Scholar
  • 8 Vargo J. Endoscopic sedation in the bariatric patient: skating on thin ice?. Dig Dis Sci 2014; 59: 2023-2024
    CrossrefPubMedGoogle Scholar
  • 9 Kobiela J, Wieszczy P, Regula J. et al. Association of obesity with colonic findings in screening colonoscopy in a large population-based study. United European Gastroenterol J 2018; 6: 1538-1546
    CrossrefPubMedGoogle Scholar
  • 10 Borg BB, Gupta NK, Zuckerman GR. et al. Impact of obesity on bowel preparation for colonoscopy. Clin Gastroenterol Hepatol 2009; 7: 670-675
    CrossrefPubMedGoogle Scholar
  • 11 Wani S, Azar R, Hovis CE. et al. Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures. Gastrointest Endosc 2011; 74: 1238-1247
    CrossrefPubMedGoogle Scholar
  • 12 Jirapinyo P, Abu Dayyeh BK, Thompson CC. Conscious sedation for upper endoscopy in the gastric bypass patient: prevalence of cardiopulmonary adverse events and predictors of sedation requirement. Dig Dis Sci 2014; 59: 2173-2177
    CrossrefPubMedGoogle Scholar
  • 13 Early DS, Lightdale JR. ASGE Standards of Practice Committee. et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2018; 87: 327-337
    CrossrefPubMedGoogle Scholar
  • 14 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96: 1004-1017
    CrossrefPubMedGoogle Scholar
  • 15 Amornyotin S. Sedation-related complications in gastrointestinal endoscopy. World J Gastrointest Endosc 2013; 5: 527-533
    CrossrefPubMedGoogle Scholar
  • 16 Hsieh YH, Kuo CS, Tseng KC. et al. Factors that predict cecal insertion time during sedated colonoscopy: the role of waist circumference. J Gastroenterol Hepatol 2008; 23: 215-217
    CrossrefPubMedGoogle Scholar
  • 17 Cirocco WC, Rusin LC. Factors that predict incomplete colonoscopy. Dis Colon Rectum 1995; 38: 964-968
    CrossrefPubMedGoogle Scholar
  • 18 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
    CrossrefPubMedGoogle Scholar
  • 19 Dafnis G, Granath F, Pahlman L. et al. Patient factors influencing the completion rate in colonoscopy. Dig Liver Dis 2005; 37: 113-118
    CrossrefPubMedGoogle Scholar
  • 20 Qureshi A, BiBi S, Madhotra R. Body mass index & low CIR in colonoscopy!. Gastroenterol Hepatol Bed Bench 2018; 11: 125-130
    PubMedGoogle Scholar
  • 21 NíMhathúna AN, Devane LA, Veitch V. et al. Obesity is associated with increased risk of colonoscopy failure. Mesentery and Peritoneum 2018; 2: AB094-AB094 DOI: 10.21037/map.2018.AB094.
    CrossrefPubMedGoogle Scholar
  • 22 Rex DK, Bond JH, Winawer S. et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2002; 97: 1296-1308
    CrossrefPubMedGoogle Scholar
  • 23 Chung YW, Han DS, Yoo KS. et al. Patient factors predictive of pain and difficulty during sedation-free colonoscopy: a prospective study in Korea. Dig Liver Dis 2007; 39: 872-876
    CrossrefPubMedGoogle Scholar
  • 24 Shah SG, Brooker JC, Thapar C. et al. Patient pain during colonoscopy: an analysis using real-time magnetic endoscope imaging. Endoscopy 2002; 34: 435-440
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 25 Rex DK. Achieving cecal intubation in the very difficult colon. Gastrointest Endosc 2008; 67: 938-944
    CrossrefPubMedGoogle Scholar
  • 26 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
    CrossrefPubMedGoogle Scholar
  • 27 Desormeaux MPSM, Friedland S. Colonoscopy in obese patients: a growing problem. Gastrointest Endosc 2008; 67: AB89
    PubMedGoogle Scholar
  • 28 Maruthur NM, Bolen S, Gudzune K. et al. Body mass index and colon cancer screening: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2012; 21: 737-746
    CrossrefPubMedGoogle Scholar
  • 29 Harewood GC, Wiersema MJ, Melton LJ. et al. A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy. Am J Gastroenterol 2002; 97: 3186-3194
    CrossrefPubMedGoogle Scholar
  • 30 Chutkan R. Colonoscopy issues related to women. Gastrointest Endosc Clin N Am 2006; 16: 153-163
    CrossrefPubMedGoogle Scholar
  • 31 Jia H, Wang L, Luo H. et al. Difficult colonoscopy score identifies the difficult patients undergoing unsedated colonoscopy. BMC Gastroenterol 2015; 15: 46
    CrossrefPubMedGoogle Scholar
  • 32 Krishnan P, Sofi AA, Dempsey R. et al. Body mass index predicts cecal insertion time: the higher, the better. Dig Endosc 2012; 24: 439-442
    CrossrefPubMedGoogle Scholar
  • 33 Nagata N, Sakamoto K, Arai T. et al. Predictors for cecal insertion time: the impact of abdominal visceral fat measured by computed tomography. Dis Colon Rectum 2014; 57: 1213-1219
    CrossrefPubMedGoogle Scholar
  • 34 Chung GE, Lim SH, Yang SY. et al. Factors that determine prolonged cecal intubation time during colonoscopy: impact of visceral adipose tissue. Scand J Gastroenterol 2014; 49: 1261-1267
    CrossrefPubMedGoogle Scholar
  • 35 Jain D, Goyal A, Uribe J. Obesity and cecal intubation time. Clin Endosc 2016; 49: 187-190
    CrossrefPubMedGoogle Scholar
  • 36 Takahashi Y, Tanaka H, Kinjo M. et al. Prospective evaluation of factors predicting difficulty and pain during sedation-free colonoscopy. Dis Colon Rectum 2005; 48: 1295-1300
    CrossrefPubMedGoogle Scholar
  • 37 Moon SY, Kim BC, Sohn DK. et al. Predictors for difficult cecal insertion in colonoscopy: The impact of obesity indices. World J Gastroenterol 2017; 23: 2346-2354
    CrossrefPubMedGoogle Scholar
  • 38 Hyun JH, Kim SJ, Park JH. et al. Lifestyle Factors and Bowel Preparation for Screening Colonoscopy. Ann Coloproctol 2018; 34: 197-205
    CrossrefPubMedGoogle Scholar
  • 39 Enestvedt BK, Brian Fennerty M, Zaman A. et al. MiraLAX vs. Golytely: is there a significant difference in the adenoma detection rate?. Aliment Pharmacol Ther 2011; 34: 775-782
    CrossrefPubMedGoogle Scholar
  • 40 Fayad NF, Kahi CJ, Abd El-Jawad KH. et al. Association between body mass index and quality of split bowel preparation. Clin Gastroenterol Hepatol 2013; 11: 1478-1485
    CrossrefPubMedGoogle Scholar
  • 41 Kuznets N. Diagnostic colonoscopy: performance measurement study. J Ambul Care Manage 2002; 25: 41-55
    CrossrefPubMedGoogle Scholar
  • 42 Hendry PO, Jenkins JT, Diament RH. The impact of poor bowel preparation on colonoscopy: a prospective single centre study of 10,571 colonoscopies. Colorectal Dis 2007; 9: 745-748
    CrossrefPubMedGoogle Scholar
  • 43 Kazarian ES, Carreira FS, Toribara NW. et al. Colonoscopy completion in a large safety net health care system. Clin Gastroenterol Hepatol 2008; 6: 438-442
    CrossrefPubMedGoogle Scholar
  • 44 Adams KF, Leitzmann MF, Albanes D. et al. Body mass and colorectal cancer risk in the NIH-AARP cohort. Am J Epidemiol 2007; 166: 36-45
    CrossrefPubMedGoogle Scholar
  • 45 Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut 2013; 62: 933-947
    CrossrefPubMedGoogle Scholar
  • 46 Jacobs ET, Martinez ME, Alberts DS. et al. Association between body size and colorectal adenoma recurrence. Clin Gastroenterol Hepatol 2007; 5: 982-990
    CrossrefPubMedGoogle Scholar
  • 47 Almendingen K, Hofstad B, Vatn MH. Does high body fatness increase the risk of presence and growth of colorectal adenomas followed up in situ for 3 years?. Am J Gastroenterol 2001; 96: 2238-2246
    CrossrefPubMedGoogle Scholar
  • 48 Qadeer MA, Rocio Lopez A, Dumot JA. et al. Risk factors for hypoxemia during ambulatory gastrointestinal endoscopy in ASA I-II patients. Dig Dis Sci 2009; 54: 1035-1040
    CrossrefPubMedGoogle Scholar
  • 49 Waring JP, Baron TH, Hirota WK. et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 2003; 58: 317-322
    CrossrefPubMedGoogle Scholar
  • 50 Gouda B, Gouda G, Borle A. et al. Safety of non-anesthesia provider administered propofol sedation in non-advanced gastrointestinal endoscopic procedures: A meta-analysis. Saudi J Gastroenterol 2017; 23: 133-143
    CrossrefPubMedGoogle Scholar
  • 51 Tierney M, Bevan R, Rees CJ. et al. What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care. Frontline Gastroenterol 2016; 7: 191-198
    CrossrefPubMedGoogle Scholar