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There are no accepted means of identifying patients in whom colonoscopy is likely to be more difficult and allocate time accordingly.To identify patient-related, endoscopist-related, and procedure-related factors associated with difficult cecal intubation.This was a prospective study performed at the Kaohsiung Chang Gung Memorial Hospital, Kaohsiung Medical Center, from January to December 2009. Data pertaining to patient information (age, sex, weight, waist circumference and buttock girth, bowel habit, and abdomen surgery history) were recorded prospectively. Procedure-specific information including the need to alter patient position, application of external compression, and cecal intubation time (CIT) was documented.A total of 859 consecutive patients were enrolled. The mean age of the patients was 50.5±11.4 years. CIT was longer in women compared with men (410±195 vs. 376±224 s; P=0.021). Older patients had longer CITs—an additional 2.1 seconds for each incremental year (P=0.001), and poor bowel preparation increased CIT (P=0.019). Patients who required a position change or abdominal compression took longer to reach the cecum (P<0.001).Our findings emphasize the importance of colon preparation and the need for abdominal compression and a change of position when performinga difficult colonoscopy.