Oh Se Yong, Sohn Chong Il, Sung In Kyung, Park Dong Il, Kang Mun Su, Yoo Tae Woo, Park Jung Ho, Kim Hong Joo, Cho Yong Kyun, Jeon Woo Kyu, Kim Byung Ik
Department of Internal Medicine, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, Korea.
Hepatogastroenterology. 2007 Jul-Aug;54(77):1403-6.
BACKGROUND/AIMS: Colonoscopy is a standard diagnostic tool for screening and surveillance of diseases affecting the colon. Colonoscopy may be painful for patients and difficult for the endoscopist. The aim of this study was to identify the factors affecting the technical difficulty of a colonoscopic examination and to predict potential difficult patients who will undergo colonoscopy.
A total of 646 outpatients were consecutively included in this study. Patient's age and gender, body mass index (BMI), prior surgical history, and the duration and symptoms of irritable bowel syndrome (IBS) were recorded before the procedure. The quality of bowel preparation, the difficulty of examination reported by the colonoscopist, the degree of patient pain, the degree of pain as reported by an observer, cecal intubation time andcolonoscopic findings were assessed after the procedure.
We evaluated the difficulty of colonoscopy by cecal intubation time. Advanced age (>50 years), female gender, low BMI (< or = 23 Kg/m2), poor bowel preparation, prior surgical history, patient pain and the presence of IBS were associated with prolonged cecal intubation time. A multivariate logistic regression analysis demonstrated that advanced age, female gender, low BMI, poor bowel preparation and patient pain were independent factors related to prolonged cecal intubation time.
In patients with advanced age, female gender and low BMI, information that colonoscopy may be difficult and painful should be provided. If a colonoscopy is not absolutely indicated, barium enema or CT colonography may be performed as alternative diagnostic modalities.
背景/目的：结肠镜检查是用于筛查和监测结肠疾病的标准诊断工具。结肠镜检查对患者来说可能很痛苦，对内镜医师来说操作也可能有难度。本研究的目的是确定影响结肠镜检查技术难度的因素，并预测即将接受结肠镜检查的潜在困难患者。
本研究连续纳入了646名门诊患者。在检查前记录患者的年龄、性别、体重指数（BMI）、既往手术史以及肠易激综合征（IBS）的病程和症状。在检查后评估肠道准备质量、结肠镜医师报告的检查难度、患者疼痛程度、观察者报告的疼痛程度、盲肠插管时间和结肠镜检查结果。
我们通过盲肠插管时间评估结肠镜检查的难度。高龄（>50岁）、女性、低BMI（≤23 Kg/m²）、肠道准备不佳、既往手术史、患者疼痛以及存在IBS与延长的盲肠插管时间相关。多因素逻辑回归分析表明，高龄、女性、低BMI、肠道准备不佳和患者疼痛是与延长的盲肠插管时间相关的独立因素。
对于高龄、女性和低BMI的患者，应告知其结肠镜检查可能困难且痛苦。如果并非绝对需要进行结肠镜检查，可选择钡剂灌肠或CT结肠成像作为替代诊断方法。
