Miller Alexander, Kamalpour Nima, Butterly Lynn F, Anderson Joseph C
Division of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
IGIE. 2024 Sep;1(3):393-400. doi: 10.1016/j.igie.2024.07.003. Epub 2024 Jul 22.
Women and older or thinner patients have lower colonoscopy cecal intubation rates. We used data from the New Hampshire Colonoscopy Registry (NHCR) to examine the association between these and other endoscopist factors and trends of colonoscopy cecal intubation rates.
Our sample included patients ≥40 years from the NHCR with an adequate bowel preparation. We examined colonoscopy completion rates over quartiles (2004-2011, 2012-2014, 2015-2017, and 2018-2021) as stratified by men versus women and body mass index (BMI). In addition to these factors, we also adjusted for age and year of examination. Other variables of interest were specialty of the endoscopist and adenoma detection rates (ADRs).
Our sample included 143,095 individuals (52.5% women [n = 75,180]). Multivariable analysis showed that BMI <25 (odds ratio [OR], .87; 95% confidence interval [CI], .76-.99), obesity (BMI ≥30) (OR, .88; 95% CI, .77-.99), and older age (per year) (OR, .96; 95% CI, .96-.97) were associated with a decreased likelihood of having a complete colonoscopy. Men were more likely than women to have a higher completion rate (OR, 1.46; 95% CI, 1.30-1.63). Gastroenterology specialty (OR, 1.78; 95% CI, 1.56-2.03) and an ADR ≥25% (OR, 2.01; 95% CI, 1.79-2.26) were associated with an increased likelihood of cecal intubation. These endoscopist-related factors were also observed to be predictive of cecal intubation in a subset of thin (BMI <25) women. Men and obese patients (BMI ≥30) were more likely to have incomplete examinations halted in the right-sided versus left-sided colon.
Even after adjusting for endoscopist factors, our study demonstrated that older or female patients and those with a BMI <25 or ≥30 had lower colonoscopy completion rates. Our data also suggest that colonoscopies performed in thin women were more likely to be completed if they were performed by a gastroenterologist as opposed to a nongastroenterologist.
女性以及年龄较大或体型较瘦的患者结肠镜检查到达盲肠的插管率较低。我们利用新罕布什尔结肠镜检查登记处（NHCR）的数据，来研究这些因素及其他内镜医师因素与结肠镜检查到达盲肠插管率趋势之间的关联。
我们的样本包括来自NHCR的年龄≥40岁且肠道准备充分的患者。我们按男性与女性以及体重指数（BMI）分层，检查了四分位区间（2004 - 2011年、2012 - 2014年、2015 - 2017年和2018 - 2021年）的结肠镜检查完成率。除了这些因素外，我们还对年龄和检查年份进行了调整。其他感兴趣的变量是内镜医师的专业和腺瘤检出率（ADR）。
我们的样本包括143,095人（52.5%为女性[n = 75,180]）。多变量分析显示，BMI < 25（比值比[OR]，0.87；95%置信区间[CI]，0.76 - 0.99）、肥胖（BMI≥30）（OR，0.88；95% CI，0.77 - 0.99）以及年龄较大（每年）（OR，0.96；95% CI，0.96 - 0.97）与结肠镜检查完整完成的可能性降低相关。男性比女性更有可能有更高的完成率（OR，1.46；95% CI，1.30 - 1.63）。胃肠病学专业（OR，1.78；95% CI，1.56 - 2.03）和ADR≥25%（OR，2.01；95% CI，1.79 - 2.26）与到达盲肠插管的可能性增加相关。在体型较瘦（BMI < 25）的女性子集中，这些与内镜医师相关的因素也被观察到可预测到达盲肠插管情况。男性和肥胖患者（BMI≥30）在右侧结肠与左侧结肠相比，更有可能出现检查不完整而终止的情况。
即使在对内镜医师因素进行调整后，我们的研究表明年龄较大或女性患者以及BMI < 25或≥30的患者结肠镜检查完成率较低。我们的数据还表明，体型较瘦的女性进行结肠镜检查时，如果由胃肠病学家而非非胃肠病学家进行操作，更有可能完成检查。
