Evaluation of Colon Pattern using Virtual CT Colonoscopy in Patients with Difficult Colonscopic Insertion

Bae, Won Yeop; Park, Jeong Hoon; Lee, Jae Hak; Park, Do Hyun; Lee, Suck Ho; Kim, Hyun Cheol; Chung, Il Kwun; Kim, Hong Soo; Park, Sang Heum; Kim, Sun Joo

Abstract

BACKGROUND/AIMS: The successful colonoscopic insertion has been predicted by several clinical factors including female gender, obesity, poor bowel preparation, and a history of surgery. In addition, anatomical differences, such as Kudo's pattern (B, C of the sigmoid colon), rotation of the hepatic and splenic flexure, and the diameter of the sigmoid colon have also been considered to affect the success of colonoscopic insertion. The aim of this study was to evaluate the anatomical factors using virtual CT colonscopy in the case where the colonoscopic insertion is difficult.
METHODS
From April 2005 to June 2005, 32 patients who experienced a delayed insertion time > or =10 minutes during colonoscopy (Group I) and other 34 patients whose insertion time was <10 minutes (Group II) were examined by virtual CT colonoscopy. The shape of the sigmoid colon was compared with Kudo's pattern, rotation of hepatic (HFR) and splenic flexure (SFR), and the diameter of the most distended sigmoid colon at the supine position (SCD) in both groups. Excessive SFR or HFR was defined if the splenic flexure or hepatic flexure was rotated by more than 360 degrees from the natural course of the colon.
RESULTS
There were significant differences between group I (M : F=16 : 16, mean age: 61.7+/-13.8, SCD: 40.9+/-7.4 mm) and group II (M : F=25 : 9, mean age: 46.9+/-11.4, SCD: 39.7+/-7.2 mm) in terms of gender, age, BMI (24.1+/-3.5 kg/m2 in group I, 23.5+/-2.1 kg/m2 in group II), and the colonoscopic insertion time (18.1 minutes in group I, 6.3 minutes in group II). The Kudo's pattern was as follows: pattern A : B : C=23.3% : 36.7% : 40.0% in group I, and pattern A : B : C=50.0% : 37.5% : 12.5% in group II. Excessive rotation of the splenic flexure was 50% in group I, and 21.9% in group II. However, there were no clinical significant difference in bowel preparation, sedation, previous bowel operation, the type of cathartics and SCD.
CONCLUSIONS
Anatomical differences can affect a difficult colonoscopic insertion, which includes shape of the sigmoid colon, excessive rotation of the splenic flexure. However a further large randomized trial study will be needed.