The effect of hysterectomy on colonoscopy completion: A systematic review and meta-analysis

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.