A randomized, controlled trial comparing real-time insertion pain during colonoscopy confirmed water exchange to be superior to water immersion in enhancing patient comfort

Cadoni, Sergio; Sanna, Stefano; Gallittu, Paolo; Argiolas, Mariangela; Fanari, Viviana; Porcedda, M.L.; Erriu, Matteo; Leung, Felix W.

doi:10.1016/j.gie.2014.07.029

Cited by 58 publications

(106 citation statements)

References 25 publications

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“…1,2 Use of carbon dioxide (CO 2 ) was recommended by a European guideline for the same purpose. 3 In unsedated patients, real-time maximum insertion pain is a validated measure 1,2 that determines whether sedation will be needed when the option of on-demand sedation is used.…”

Section: Q10mentioning

confidence: 99%

“…Patients ingested a split-dose bowel preparation. 1,5 Demographic data, previous abdominal surgery, indication for colonoscopy, comorbidities, and current medications were recorded.…”

Section: Randomization and Study Proceduresmentioning

confidence: 99%

“…1 There was no restriction of the volume of water needed to reach the cecum. 1 Water immersion involved the infusion of water during insertion, mainly to open the lumen and progress to the cecum without attempting to clear the colon contents. Residual colonic air was not removed.…”

Section: Randomization and Study Proceduresmentioning

confidence: 99%

“…Residual colonic air was not removed. 1 Infused water and residual feces were suctioned back predominantly during withdrawal. 1,6 Ten seconds of insufflation were allowed if the endoscopists found it necessary to advance the colonoscope because the lumen could not be seen clearly.…”

Section: Randomization and Study Proceduresmentioning

confidence: 99%

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Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy

Cadoni¹,

Falt²,

Gallittu³

et al. 2015

Clinical Gastroenterology and Hepatology

Self Cite

101

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Section: Q10mentioning

confidence: 99%

“…Patients ingested a split-dose bowel preparation. 1,5 Demographic data, previous abdominal surgery, indication for colonoscopy, comorbidities, and current medications were recorded.…”

Section: Randomization and Study Proceduresmentioning

confidence: 99%

Section: Randomization and Study Proceduresmentioning

confidence: 99%

Section: Randomization and Study Proceduresmentioning

confidence: 99%

See 2 more Smart Citations

Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy

Cadoni¹,

Falt²,

Gallittu³

et al. 2015

Clinical Gastroenterology and Hepatology

Self Cite

101

View full text Add to dashboard Cite

“…Improved adenoma detection might be due to the cleansing effects of water infusions on the mucosa [71]. Although there is evidence that water exchange colonoscopy compared to the water immersion technique further reduces patient discomfort during colonoscopy [72], data showing overall superiority for ADR are still missing. However, Hsieh et al [73] could find an increased ADR in the right hemicolon in a prospective, single center, patient-blinded trial.…”

Section: Technical Aspectsmentioning

confidence: 99%

Endoscopic Improvement of the Adenoma Detection Rate during Colonoscopy - Where Do We Stand in 2015?

Floer

Meister²

2016

Digestion

238

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Background: The presence of colorectal adenomas is considered a major risk factor for colorectal cancer development. The implementation of screening colonoscopy programs in the Western world has led to a substantial reduction of colorectal cancer death. Many efforts have been made to reduce the adenoma miss rates by the application of new endoscopic devices and techniques for better adenoma visualization. Summary: This special review gives the readership an overview of current endoscopic innovations that can aid in the increase of the adenoma detection rate (ADR) during colonoscopy. These innovations include the use of devices like EndoCuff® and EndoRings® as well as new technical equipment like third-eye endoscope® and full-spectrum endoscopy (FUSE®). Key Message: Technical improvements and newly developed accessories are able to improve the ADR. However, additional costs and a willingness to invest into potentially expensive equipment might be necessary. Investigator-dependent skills remain the backbone in the ADR detection.

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The impact of water‐aided methods on pain reduction and adenoma detection rate during colonoscopy

Hsieh

Leung

2018

Adv in Digestive Medicine

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With the nationwide colorectal cancer screening program in place in Taiwan, there is an urgent need to promote techniques with a positive impact on adenoma detection rate (ADR) to minimize the risk of interval cancers. Despite widespread use of sedation, many patients in Taiwan still undergo unsedated or minimally sedated colonoscopy. Techniques that minimize pain will enhance the experience of colonoscopy, and facilitate participation in screening and surveillance. A review of water‐aided colonoscopy is appropriate at this time. Water exchange (WE), in particular, appears to be able to meet the needs of colonoscopy patients in Taiwan. Water‐aided methods are distinguished into water immersion (WI) and WE by the timing of removal of infused water—WI during withdrawal and WE during insertion. Both methods are typically performed with air pump turned off during the insertion phase of colonoscopy and thus are reported to produce less insertion pain as compared with traditional air insufflation (AI). Some colonoscopists do not require air exclusion with WI. The removal of water during insertion phase of colonoscopy, coupled with suctioning of residual air pockets, further enhance the pain reduction by WE. Head‐to‐head comparison of AI, WI, and WE has shown that WE reduced insertion pain to a greater extent than WI. Recent studies also showed that WE produced less insertion pain, with more patients completing colonoscopy without pain as compared with carbon dioxide (CO2) insufflation. WE also provides salvage cleaning during insertion and reduces distraction to inspection during withdrawal, both of which might help the colonoscopist to find more polyps. In recent randomized controlled trials comparing AI, WI, and WE, the secondary outcomes of overall ADR and right colon or proximal colon ADR were in favor of WE, but not WI. In conclusion, with practice WE is an easy and inexpensive way of insertion during colonoscopy. Its ability to reduce insertion pain and increase ADR may help improve the quality of colonoscopy. Colonoscopists in Taiwan should consider contributing to a study to assess whether the increase in ADR by WE is reproducible, and if so, whether the occurrence of interval cancers can be reduced or avoided.

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A randomized, controlled trial comparing real-time insertion pain during colonoscopy confirmed water exchange to be superior to water immersion in enhancing patient comfort

Cited by 58 publications

References 25 publications

Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy

Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy

Endoscopic Improvement of the Adenoma Detection Rate during Colonoscopy - Where Do We Stand in 2015?

The impact of water‐aided methods on pain reduction and adenoma detection rate during colonoscopy

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