Gender-specific aspects in gastrointestinal endoscopy

Gender-specific aspects in flexible endoscopy constitute an upcoming field of research in visceral medicine. They are not only based on differences in gene signatures, sex hormones and immunogenicity but moreover related to anatomic differences of the abdomen and small pelvis. To date, there is only minor evidence mostly derived from smaller endoscopic studies focusing on the topic. Large-scale studies are only available for gender differences in colonoscopy. It is well known that particularly slim female patients have asignificant higher risk of more difficult and incomplete procedures. Regarding sedation there is evidence that women awaken faster after propofol-based sedation than men. This might be due to differences in metabolization. The risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is clearly higher for younger women; however an evidence-based explanation is still lacking. There are no published data showing gender differences for procedures like esophagogastroduodenoscopy (EGD) and enteroscopy. In conclusion, the analysis and evaluation of gender and sex differences in flexible endoscopy is at its early beginnings. However, gender aspects should be integrated when planning and rolling-out prospective randomized clinical trials in endoscopy.