Intestinal flexture1/4/2024 Most subjects were 50–60 years old and had a body mass index (BMI) of 25–35 (significantly higher in M than in F). Most patients (60%) were referred for diagnostics because of abdominal pain. Only patients without abdominal or pelvic surgery or colonic disease were included. We established the border between younger and older patent as 60 years. Patients were eligible for the study if they were aged at least 20. Patients, examiners, CT equipment and image analysisĬTs were performed in 224 patients: 94 female (F), 130 male (M) fasting (at least 4 h before examination) adult patients at the Provincial Specialist Hospital in Legnica, Poland. The same group of patients was used for the analysis of the position of the descending-sigmoid flexure in the abdominal cavity (Wozniak et al. The project design was approved by the local ethics committee of the Medical University of Wroclaw (Decision No. No informed consent was obtained from patients to participate in this study. The provisions of the 1964 WMA Declaration of Helsinki (with further revisions) and Good Clinical Practice were the basis for conducting of our retrospective study (a post hoc design). We hypothesized that there were a difference between patients’ anthropometric parameters and number of colon flexures which could interfere with the endoscopic examination course. The aim of this study was to analyze the acute colon flexures and, on this basis, create a simple algorithm that can be used in the development of an AI system to classify patients according to predicted difficulty of colonoscopy. It can also be used to assess the quality of bowel preparation before the examination (Gubatan et al. It has been used to detect and characterize polyps, mucosal healing, and inflammatory bowel dysplasia during colonoscopy. It has recently been shown that AI can be developed and applied for colonoscopy or wireless capsule endoscopy (Aoki et al. This investigation is a good platform for the development of other models that can be used for a new modern technology, for example based on artificial intelligence (AI) tools. The colon can be examined by imaging methods, including computed tomography (CT).ĬT is used for follow-up of various viscera, including the intestine (Cai et al. Based on the known anatomic description, we expect four or five flexures with acute angles. The number of flexures correlated with difficulty in performing colonoscopy, but no further analyses were performed on correlations with other patient parameters. The number of acute colonic flexures was determined to be 9–11 (range 5–19) (Eickhoff et al. Other bends (more than 90°) are termed obtuse (Wozniak et al. They are called acute (or sharp) when they bend at an angle of 90° or less. The colonic flexures (other names: bendings, bends, flexions or angulations-defined as focal angle) are located between the segments and form its tortuosity. The colon consists of intestinal segments attached to the abdominal wall or suspended from mesenteries in the abdominal cavity. On this basis, we predicted troublesome colonoscopies in 14.9% female and in 6.1% male subjects. There are opportunities to use the number of acute flexures (4–7, 8–12, more than 12 flexures) to classify patients into appropriate risk categories for future incomplete colonoscopy. Older subjects had more acute flexures in the descending colon than younger subjects. In the transverse colon, older and female subjects had more flexures than younger and male subjects, respectively. We found the greatest variability in the number of acute flexures in the sigmoid colon (0–9), but no correlation was found between the number of acute flexures and age, gender, height or BMI. In addition, more acute flexions were found in women than in men and in older women (after 60 years) and men (after 80 years) than in younger ones. We determined the number of acute flexions in females to be 9.74 ± 2.5 (min–max: 4–15) and in males to be 8.7 ± 2.75 (min–max: 4–20). An artificial intelligence algorithm was proposed to predict the course of colonoscopy. Data were analyzed for correlation with gender, age, height and weight. The number of acute (angle not exceeding 90°) bends between adjacent colonic segments was noted and analyzed. Computed tomography scans of the abdominal cavity were performed in 224 (94 female, 130 male) adult subjects. Tortuosity of the colon is an important parameter for predicting the course of colonoscopy.
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