The water method combined with chromoendoscopy enhances adenoma detection

Abstract

Background:The water method is easy-to-learn and improves colonoscopy outcomes. Dye-spray chromoendoscopy enhances ADR but has not been widely accepted for routine application in screening or surveillance colonoscopy. Hypothesis: With dye added to the water used in the water method, ADR can be enhanced compared with the water or air method alone. Objective: To compare ADR determined by the air method, water method alone, and water method with indigo carmine (0.008%) added. Design: Review of prospectively collected data in a performance improvement program. Setting: VA endoscopy unit. Patient: Screening or surveillance colonoscopy. Methods: Patients (n=50/group) underwent colonoscopy with each of the three methods. Water method involved warm water infusion in lieu of air insufflation coupled with removal of residual air by suction and residual feces by water exchange. ADR and procedural data were collected prospectively to monitor performance. Main Outcome Measurements: ADR. Results: ADR in the air method, water method alone and water method with indigo carmine were 36%, 40% and 62%, respectively. Water method with indigo carmine produced significantly higher ADR than the air or water method alone (p<0.05). Limitations: Non-randomized data, single VA site, retrospective comparison. Absence of significant difference between air and water methods could be a type II error due to small number of patients Conclusions: The approach with indigo carmine added to the water used in the water method yielded significantly higher ADR than the water or the air method alone. The data suggest that a prospective RCT to compare the different methods is warranted.

Indigocarmine added to the water exchange method enhances adenoma detection - a RCT

“…[8][9] The addition of indigocarmine to the water method showed a significantly higher ADR compared to the water method using plain water and the conventional air method. 10 In this study, we performed a RCT to evaluate the potential benefits of adding indigocarmine to the water method compared to the standard water method in adenoma detection in patients undergoing screening colonoscopy. We test the hypothesis that with dye added to the water used in the water method, ADR can be enhanced.…”

Can Technology Improve the Quality of Colonoscopy?

“…Chromoendoscopy was associated with a 67 % greater chance of finding at least one neoplastic lesion in a patient and a 2.5-fold increased chance of detecting three or more neoplastic lesions [35•]. An interesting study comparing air insufflation to indigo carmine-stained water-aided colonoscopy found significantly higher ADR when dyed water was used for insufflation (ADR 36 % air insufflation vs. 40 % water insufflation vs. 62 % dyed water) [36].…”

Chromocolonoscopy for colorectal cancer screening: Dive into the Big Blue

“…These findings are intriguing, and are similar to a previous study published by the same group of investigators. 10 In that study, data collected prospectively in a performance improvement program (nonrandomized) showed ADRs in the air, water, and water-indigocarmine methods of 36%, 40%, and 62%, respectively. In the present RCT, the number of patients randomized was 84 per group, which is presumably based on the former pilot study.…”

“…This concentration was chosen on the basis on preliminary work done by the investigators to find an optimal indigocarmine concentration which would allow visualization of the colonic lumen during insertion, and not hamper the water method. 10 However, the resulting effluent is dilute and at this low concentration, the dye does not pool effectively and mucosal contrast highlighting is faint. Additional details regarding the characteristics of the excess adenomas found in the waterindigocarmine group would have helped clarify whether the dye contributed independently to the increased ADR; for example, finding more diminutive and flat adenomas as well as non-neoplastic lesions in the chromoendoscopy group would be consistent with what is expected based on the literature.…”