P1458 - Abdominal Pressure and Position Changes During Colonoscopy, How Common? And When to Expect?

Alyssa Grossen, MD¹, Maham Khan, MD¹, Nimrah Bader, MBBS¹, Bryce Yohannan, MD¹, Thomas J. Corredine, DO², Mohammad Madhoun, MD, MS^1
1University of Oklahoma Health Sciences Center, Oklahoma City, OK; ²Prime Healthcare, PC, Avon, CT

Introduction: Investigation of the gastrointestinal tract for colorectal disease is most effectively achieved through a colonoscopy. One known obstacle is looping of the colonoscope, which can lead to incomplete examination, extended operation time, patient discomfort, and even colonic perforation. Ancillary maneuvers, such as abdominal pressure and patient position changes, are often employed to correct looping.



We aimed to identify factors associated with the need for abdominal pressure and patient position change during colonoscopy.




Methods: This was a cross-sectional study of 765 individuals undergoing colonoscopy at the Oklahoma City Veterans Affairs Medical Center. Need for abdominal pressure or change in position during colonoscopy for cecal intubation was assessed using a questionnaire filled by the performing endoscopist at the end of procedure. Information regarding cecal intubation time, sedation used, demographics, comorbidities, surgical history, and medications used were extracted from the medical record. A multivariate regression analysis was performed to identify factors associated with the need for either abdominal pressure or patient position changes. A P-value < 0.05 was considered significant.

Results: 502 (65.6%) colonoscopies involved a fellow trainee, 263 (34.4%) were performed by attending only. 486 (63.5%) were performed under moderate sedation, while 279 (35.5%) were performed under monitored anesthesia care. Cecal intubation was achieved in all but one colonoscopy (99.9%). Patient position change was required in 111 (14.5%) cases, abdominal pressure was required in 281 (36.8%), and either in 310 (40.6%). African American (OR=2.5, 95% CI: 1.6, 3.8), history of obstructive sleep apnea (OR=1.7, 95% CI: 1.2, 2.3), hypothyroidism (OR=1.6, 95% CI: 1.0, 2.5), and fellow’s involvement (OR=2.7, 95% CI: 1.9,3.9) were significantly associated with higher need for either abdominal pressure or patient position change during colonoscopy (Table 1).

Discussion: A higher need for abdominal pressure and patient position change was identified in fellow-driven colonoscopies compared with attending alone, highlighting the importance of proper endoscopic technique and competency. Several other independent non-modifiable factors were identified. Anticipating those risk factors and implementing strategies, such as the water immersion technique, to mitigate them can be helpful to ensure successful colonoscopy.

	OR ratio	P value	95% Wald Confidence Limits
African American Race	2.45	< 0.0001	1.58	3.84
Obstructive Sleep Apnea	1.66	0.003	1.18	2.31
Hypothyroidism	1.60	0.046	1.00	2.54
Fellows Involvement	2.72	< 0.0001	1.89	3.89
Hypertension	1.21	0.25	0.88	1.67
Chronic Obstructive Pulmonary Disease	1.48	0.07	0.97	2.29
Moderate sedation	1.39	0.06	0.99	1.96
BMI > 40	1.41	0.20	0.83	2.41

Table: Table 1: Multivariate Analysis


Disclosures:
Alyssa Grossen indicated no relevant financial relationships.
Maham Khan indicated no relevant financial relationships.
Nimrah Bader indicated no relevant financial relationships.
Bryce Yohannan indicated no relevant financial relationships.
Thomas Corredine indicated no relevant financial relationships.
Mohammad Madhoun indicated no relevant financial relationships.


Alyssa Grossen, MD¹, Maham Khan, MD¹, Nimrah Bader, MBBS¹, Bryce Yohannan, MD¹, Thomas J. Corredine, DO², Mohammad Madhoun, MD, MS¹. P1458 - Abdominal Pressure and Position Changes During Colonoscopy, How Common? And When to Expect?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.