J Gastric Cancer.  2016 Sep;16(3):167-176. 10.5230/jgc.2016.16.3.167.

Effect of Previous Gastrectomy on the Performance of Postoperative Colonoscopy

• Kim S
• Choi J
• Kim TH
• Kong SH
• Suh YS
• Im JP
• Lee HJ
• Kim SG
• Jeong SY
• Kim JS
• Yang HK

• KMID: 2372560
• DOI: http://doi.org/10.5230/jgc.2016.16.3.167

Abstract

PURPOSE
The purpose of this study was to determine the effect of a prior gastrectomy on the difficulty of subsequent colonoscopy, and to identify the surgical factors related to difficult colonoscopies.
MATERIALS AND METHODS
Patients with a prior gastrectomy who had undergone a colonoscopy between 2011 and 2014 (n=482) were matched (1:6) to patients with no history of gastrectomy (n=2,892). Cecal insertion time, intubation failure, and bowel clearance score were compared between the gastrectomy and control groups, as was a newly generated comprehensive parameter for a difficult/incomplete colonoscopy (cecal intubation failure, cecal insertion time >12.9 minutes, or very poor bowel preparation scale). Surgical factors including surgical approach, extent of gastrectomy, extent of lymph node dissection, and reconstruction type, were analyzed to identify risk factors for colonoscopy performance.
RESULTS
A history of gastrectomy was associated with prolonged cecal insertion time (8.7±6.4 vs. 9.7±6.5 minutes; P=0.002), an increased intubation failure rate (0.1% vs. 1.9%; P<0.001), and a poor bowel preparation rate (24.7 vs. 29.0; P=0.047). Age and total gastrectomy (vs. partial gastrectomy) were found to be independent risk factors for increased insertion time, which slowly increased throughout the postoperative duration (0.35 min/yr). Total gastrectomy was the only independent risk factor for the comprehensive parameter of difficult/incomplete colonoscopy.
CONCLUSIONS
History of gastrectomy is related to difficult/incomplete colonoscopy performance, especially in cases of total gastrectomy. In any case, it may be that a pre-operative colonoscopy is desirable in selected patients scheduled for gastrectomy; however, it should be performed by an expert endoscopist each time.

Keyword

Colonoscopy; Risk factors; Gastrectomy; Postoperative period; Time

MeSH Terms

Colonoscopy*
Gastrectomy*
Humans
Intubation
Lymph Node Excision
Postoperative Period
Risk Factors

Figure

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  Fig. 1 Relationship between the insertion time and the postoperative duration. Error bars represent the standard deviation.

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  Fig. 2 (A) Relationship between the insertion time and the bowel clearance score in control group. (B) Relationship between the insertion time and the bowel clearance score in gastrectomy group. *P-value compared with ANOVA. †P-value compared with t-test.

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