Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 12, December, p. 1627–1632

doi: 10.17219/acem/104547

Publication type: original article

Language: English

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New colon anatomy-related ratios used to predict the course of colonoscopy in children

Sławomir Woźniak1,A,B,C,D,E, Tomasz Pytrus2,A,B,C,E,F, Marek Woynarowski3,C,E,F, Bartosz Puła4,C,E,F, Zygmunt Domagała1,E,F, Barbara Iwańczak2,C,E,F

1 Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Poland

2 2nd Department and Clinic of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland

3 Department of Gastroenterology, Hepatology and Immunology. The Children’s Memorial Health Institute, Warszawa, Poland

4 Department of Hematology, Institute of Hematology and Transfusion Medicine, Warszawa, Poland


Background. In children, colonoscopy is a safe procedure, although it is more difficult to perform in patients whose body mass index (BMI) is under 25.
Objectives. The aim of the study was to establish the relationship between children’s age, body mass and height and incomplete colonoscopies due to colon anatomy.
Material and Methods. A retrospective evaluation of diagnostic endoscopies in 403 children aged 3–18 years (192 girls and 211 boys) was performed. New ratios were introduced: the incomplete colonoscopy anatomy-related ratio (ICAR) and the modified incomplete colonoscopy anatomy-related ratio (MICAR).
Results. The terminal ilium was not reached in 59 children: 27 girls and 32 boys (14.6% of patients). In 13 girls and 18 boys (comprising 7.69% of the study population) no pathological causes were found for the incomplete colonoscopy. There were statistically significant differences concerning colon anatomy-related incomplete colonoscopies in relation to the children’s weight. No significance was found in relation to height or age. Incomplete examinations were more frequent in patients weighing less than 30 kg (p = 0.0006), both in boys (p = 0.0090) and girls (p = 0.048). The risk of incomplete colonoscopy (odds ratio – OR) in boys and girls weighing less than 30 kg was 3.995 (95% CI = 1.489–10.720) and 3.373 (95% CI = 1.078–10.560), respectively. For this group of patients, the ICAR ranged between 0.0309 and 0.1889, while the MICAR range was 0.0–0.1889.
Conclusion. Body mass is a statistically significant factor for evaluating the risk of incomplete colonoscopies in children. The lower the ICAR and MICAR values, the lower the risk of non-completion of a colonoscopy due to anatomical (i.e., disease-unrelated) causes.

Key words

pediatric colonoscopy, incomplete colonoscopy, colon anatomy-related incomplete colonoscopy

References (31)

  1. Bourgouin S, Bège T, Lalonde N, et al. Three-dimensional determination of variability in colon anatomy: Applications for numerical modeling of the intestine. J Surg Res. 2012;178(1):172–180.
  2. Eickhoff A, Pickhardt PJ, Hartmann D, Riemann JF. Colon anatomy based on CT colonography and fluoroscopy: Impact on looping, straightening and ancillary maneuvers in colonoscopy. Dig Liver Dis. 2010;42(4):291–296.
  3. Struijs M-C, Diamond IR, de Silva N, Wales PW. Establishing norms for intestinal length in children. J Pediatr Surg. 2009;44(5):933–938.
  4. Hanson ME, Pickhardt PJ, Kim DH, Pfau PR. Anatomic factors predictive of incomplete colonoscopy based on findings at CT colonography. AJR Am J Roentgenol. 2007;189(4):774–779.
  5. Khashab MA, Pickhardt PJ, Kim DH, Rex DK. Colorectal anatomy in adults at computed tomography colonography: Normal distribution and the effect of age, sex, and body mass index. Endoscopy. 2009;41(8):674–678.
  6. Alazmani A, Hood A, Jayne D, Neville A, Culmer P. Quantitative assessment of colorectal morphology: Implications for robotic colonoscopy. Med Eng Phys. 2016;38(2):148–154.
  7. Punwani S, Halligan S, Tolan D, Taylor SA, Hawkes D. Quantitative assessment of colonic movement between prone and supine patient positions during CT colonography. Br J Radiol. 2009;82(978):475–481.
  8. Spada C, Hassan C, Barbaro B, et al. Colon capsule versus CT colonography in patients with incomplete colonoscopy: A prospective, comparative trial. Gut. 2015;64(2):272–281.
  9. Brenner H, Chang-Claude J, Jansen L, Seiler CM, Hoffmeister M. Role of colonoscopy and polyp characteristics in colorectal cancer after colonoscopic polyp detection: A population-based case-control study. Ann Intern Med. 2012;157(4):225–232.
  10. Kamiński M, Hassan C, Bisschops R, et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2014;46(5):435–457.
  11. Rees CJ, Rajasekhar PT, Rutter MD, Dekker E. Quality in colonoscopy: European perspectives and practice. Expert Rev Gastroenterol Hepatol. 2014;8(1):29–47.
  12. Thakkar K, Holub JL, Gilger MA, et al. Quality indicators for pediatric colonoscopy: Results from a multicenter consortium. Gastrointest Endosc. 2016;83(3):533–541.
  13. Niv Y, Hazazi R, Levi Z, Fraser G. Screening colonoscopy for colorectal cancer in asymptomatic people: A meta-analysis. Dig Dis Sci. 2008;53(12):3049–3054.
  14. Rathgaber SW, Wick TM. Colonoscopy completion and complication rates in a community gastroenterology practice. Gastrointest Endosc. 2006;64(4):556–562.
  15. Gawron AJ, Veerappan A, McCarthy ST, Kankanala V, Keswani RN. Impact of an incomplete colonoscopy referral program on recommendations after incomplete colonoscopy. Dig Dis Sci. 2013;58(7):1849–1855.
  16. Morini S, Zullo A, Hassan C, Lorenzetti R, Campo SMA. Endoscopic management of failed colonoscopy in clinical practice: To change endoscopist, instrument, or both? Int J Colorectal Dis. 2011;26(1):103–108.
  17. Wehrmann T, Lechowicz I, Martchenko K, Riphaus A. Routine colonoscopy with a standard gastroscope. A randomized comparative trial in a Western population. Int J Colorectal Dis. 2008;23(4):443–446.
  18. 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(10):1261–1267.
  19. Hsieh Y-H, Kuo C-S, Tseng K-C, Lin H-J. Factors that predict cecal insertion time during sedated colonoscopy: The role of waist circumference. J Gastroenterol. 2008;23(2):215–217.
  20. 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(10):1213–1219.
  21. Shah HA, Paszat LF, Saskin R, Stukel TA, Rabeneck L. Factors associated with incomplete colonoscopy: A population-based study. Gastroenterol-ogy. 2007;132(7):2297–2303.
  22. Iqbal CW, Askegard-Giesmann JR, Pham TH, Ishitani MB, Moir CR. Pediatric endoscopic injuries: Incidence, management, and outcomes. J Pediatr Surg. 2008;43(5):911–915.
  23. Tringali A, Balassone V, De Angelis P, Landi R. Complications in pediatric endoscopy. Best Pract Res Clin Gastroenterol. 2016;30(5):825–839.
  24. Madiba TE, Haffajee MR. Sigmoid colon morphology in the population groups of Durban, South Africa, with special reference to sigmoid volvulus. Clin Anat. 2011;24(4):441–453.
  25. Madiba TE, Haffajee MR, Sikhosana MH. Radiological anatomy of the sigmoid colon. Surg Radiol Anat. 2008;30(5):409–415.
  26. Sadahiro S, Ohmura T, Yamada Y, Saito T, Taki Y. Analysis of length and surface area of each segment of the large intestine according to age, sex and physique. Surg Radiol Anat. 1992;14(3):251–257.
  27. Phillips M, Patel A, Meredith P, Will O, Brassett C. Segmental colonic length and mobility. Ann R Coll Surg Engl. 2015;97(6):439–444.
  28. Krishnan P, Sofi AA, Dempsey R, Alaradi O, Nawras A. Body mass index predicts cecal insertion time: The higher, the better. Dig Endosc. 2012;24(6):439–442.
  29. Franciosi JP, Mascarenhas M, Semeao E, Flick J, Kelly J, Mamula P. Randomised controlled trial of paediatric magnetic positioning device assisted colonoscopy: A pilot and feasibility study. Dig Liver Dis. 2009;41(2):123–126.
  30. Holme Ö, Höie O, Matre J, et al. Magnetic endoscopic imaging versus standard colonoscopy in a routine colonoscopy setting: A randomized, controlled trial. Gastrointest Endosc. 2011;73(6):1215–1222.
  31. Lightdale JR, Acosta R, Shergill AK, et al; ASGE Standards of Practice Committee; American Society for Gastrointestinal Endoscopy. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc. 2014;79(5):699–710.