1317
DISEASES OF THE COLON & RECTUM VOLUME 57: 11 (2014)
BACKGROUND: The primary aim of colonoscopy is a
complete and thorough examination of the colon. There
are a number of factors, however, that can potentially
increase the difficulty of completing a colonoscopy. A
significant proportion of women eligible for colorectal
cancer screening have undergone hysterectomy. A
history of hysterectomy is frequently considered to
make colonoscopy more difficult, although there is no
consensus in the literature.
OBJECTIVE: The aim of this study is to assess the effect of
hysterectomy on colonoscopy completion.
DATA SOURCES: A systematic search of PubMed, Embase,
and the Cochrane database identified 6 eligible studies.
STUDY SELECTION: Studies that compared colonoscopy
completion rates in women with a previous history
of hysterectomy and women with no history of pelvic
surgery were selected for review.
INTERVENTION: Meta-analysis was performed by using
random-effects methods.
MAIN OUTCOME MEASURES: The primary outcome used
was colonoscopy completion rate. The outcomes were
calculated as odds ratio with 95% CI.
RESULTS: A total of 5947 patients were included in
the final analysis. The average hysterectomy rate was
26.3% ± 14.5%. The colonoscopy completion rate
was significantly reduced in patients with a history of
hysterectomy compared with those with no history of
pelvic surgery (87.1% vs 95.5%) (OR, 0.28; 95% CI, 0.16–
0.49; p < 0.001). Analysis of the funnel plot demonstrated
nonsignificant across-study publication bias. There was
significant across-study heterogeneity (Cochran Q, 19.6;
p = 0.002).
LIMITATIONS: The endoscopist's experience is poorly
defined in some studies. Indication for colonoscopy was
not provided in all cases. There is significant across-study
heterogeneity.
CONCLUSION: Colonoscopy completion rates appear
decreased in women with a history of hysterectomy, but
the available literature is heterogenous. Further studies in
this area are warranted.
KEY WORDS: Hysterectomy; Colonoscopy; Completion;
Cecal intubation.
T
he primary aim of colonoscopy is a complete and
thorough examination of the colon. To ensure that
standards are achieved and maintained in centers
performing screening colonoscopies, a number of qual-
ity measures have been introduced by governing bodies
such as the British Society of Gastroenterology and the
Association of Coloproctology of Great Britain and Ire-
land. Among these standards are a minimum number of
colonoscopies per annum, adequate bowel preparation
rates, and adequate sedation rates.
1
The key performance
indicator of adequate colonoscopy is the cecal intubation
rate. Cecal intubation rates of 90% (adjusted for poor
bowel preparation and mechanical obstruction) and 95%
have been recommended by the National Health Service
(UK) and the US Multi-Society Task Force on Colorectal
Cancer.
1,2
There are a number of factors, however, that can
The Efect of Hysterectomy on Colonoscopy
Completion: A Systematic Review and
Meta-Analysis
Cillian Clancy, M.B., B.Ch., M.R.C.S.I.
1
•JohnP.Burke,Ph.D.,F.R.C.S.I.
1
Kah Hoong Chang, M.D., M.R.C.S.I
1
•J.CalvinCoffey,Ph.D.,F.R.C.S.I
2
1 Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
2 4i Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School,
University of Limerick, Limerick, Ireland
Dis Colon Rectum 2014; 57: 1317–1323
DOI: 10.1097/DCR.0000000000000223
© The ASCRS 2014
Financial Disclosures: None reported.
Correspondence: Cillian Clancy, M.B., B.Ch., M.R.C.S.I., Department
of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland.
E-mail: clancyci@tcd.ie
CURRENT STATUS