Feasibility of colonoscopy with water infusion in minimally sedated patients in an Asian community setting

Abstract

Background: Investigators in the Us described large volume water infusion with marked benefits but acknowledged the limitation of male veteran predominance in the study subjects. The aim of this study was to assess the feasibility of large volume water infusion in asian patients undergoing minimal sedation diagnostic colonoscopy in a community setting. Methods: consecutive patients who underwent colonoscopy were randomized to receive large volume (entire colon) (Group a, n=51), limited volume (rectum and sigmoid colon) (Group B, n=51) water infusion, or air insufflation (Group c, n=51). pain during insertion, completion rate, cecal intubation and total procedure times, and patient satisfaction were evaluated. pain and satisfaction were assessed with a 0-10 visual analog scale. Results: The mean pain scores during insertion were lower in the Group a and Group B than in Group c, 3.3±2.4, 3.0±2.2 and 4.4±2.6, respectively (p=0.028 and p=0.004). The completion rates and cecal intubation times were similar among the three groups. The procedure time was significantly longer in Group a than in group c (15.3±5.9 min vs. 13.1±5.4 min, p=0.049). Overall satisfaction with the procedure was greater in Group B than in Group c only (9.7±0.5 vs. 9.4±0.8, p=0.044). Conclusions: Diagnostic colonoscopy with large volume water infusion without air insufflation appears to be feasible in minimally sedated asian patients in a community setting. Measures to improve the outcome further are discussed.

The water exchange method for colonoscopy-effect of coaching

“…6,7 Water immersion is relatively easy to apply as the colonoscopist retains the discretion to employ the more familiar modality of air insufflation throughout the examination. When water immersion was used in RCT authors either did not report the need for training [6][7][8]11,13,16,17 or described practice in 30 12 to 40 18 cases prior to the start of randomization.…”

“…[1][2][3] With water immersion, an established adjunct to air insufflation since at least 1984, 4 infused water is conveniently removed predominantly during withdrawal. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] With water exchange, a novel approach without use of air insufflation, infused water is removed predominantly during insertion. Recent reviews of randomized controlled trials (RCT) comparing air insufflation with water immersion or water exchange 1,2 generated provocative discussions.…”

Water-aided colonoscopy: a systematic review

“…6 The call for randomized, controlled trials (RCTs) to evaluate these methods 1 led to a plethora of RCTs that used variations of the theme. 2,[7][8][9][10][11][12][13][14][15][16][17] In this review, we aim to assess the impact of water-aided methods on colonoscopy pain and ADR. …”

Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

“…14,15 After the procedure the patients and the orthopaedic surgeons were asked for a satisfaction scoring which was demonstrated by using (0-100 mm) Visual Analogue Scale. 16,17 Patients were asked whether they would receive the same method of sedation and analgesia if needed in the future and the physicians were asked whether they are satisfied about the degree of convenience of the manipulation.…”