Factors of easy and difficult cecal intubation during unsedated colonoscopy

Successful colonoscopy can prevent from the occurrence and progression of colorectal cancer. Rapid cecal intubation is an important indicator of successful colonoscopy, which depends on both endoscopists and patients. Experienced endoscopists can quickly insert the endoscope to the cecum, thereby shortening the duration of colonoscopy and reducing the patients' discomfort. However, it is unclear about which type of patients are more difficult to intubate the cecum. If such patients can be identified, we can choose more skilled endoscopists or perform sedated colonoscopy, so as to increase the rate of successful colonoscopy. Therefore, we conducted this study to identify the factors associated with easy and difficult cecal intubation during unsedated colonoscopy. We retrospectively collected the variables, including age, gender, body mass index, reasons for colonoscopy, position change during colonoscopy, bowel preparation quality, cecal intubation time, and major colonoscopic findings, and defined easy and difficult cecal intubation according to the cecal intubation time. We found that patients who were younger, male, and obese without requirement of position change during colonoscopy were more likely to have easy cecal intubation, but those who were older, female, and thin, required position change during colonoscopy, and had insufficient bowel preparation were more likely to have difficult cecal intubation. These findings may help determine the necessity of sedation for a colonoscopy and the selection of a skilled endoscopist. Background and aims: difficulty of cecal intubation should be a main indicator for the need of sedated colonoscopy and skilled endoscopists. The present study aimed to explore the factors associated with easy and difficult cecal intubation in unsedated colonoscopy. Methods: all consecutive patients who underwent unsedated colonoscopy at our department by the same endoscopist from December 3, 2020 to August 30, 2022 were retrospectively collected. Age, gender, body mass index (BMI), reasons for colonoscopy, position change, Boston Bowel Preparation Scale score, cecal intubation time (CIT) and major colonoscopic findings were analyzed. CIT < 5 min, CIT 5-10 min and CIT > 10 min or failed cecal intubation were defined as easy, moderate and difficult cecal intubation, respectively. Logistic regression analyses were performed to identify independent factors associated with easy and difficult cecal intubation. Results: overall, 1,281 patients were included. The proportions of easy and difficult cecal intubation were 29.2 % (374/1,281) and 27.2 % (349/1,281), respectively. Multivariate logistic regression analysis found that age <= 50 years, male, BMI > 23.0 kg/m(2) and the absence of position change were independently associated with easy cecal intubation, and that age > 50 years, female, BMI <= 23.0 kg/m(2), position change, and insufficient bowel preparation were independently associated with difficult cecal intubation. Conclusions: some convenient factors independently associated with easy and difficult cecal intubation have been identified, which will be potentially helpful to determine whether a colonoscopy should be sedated and a skilled endoscopist should be selected. The current findings should be further validated in large-scale prospective studies.