The water method is effective in difficult colonoscopy—it enhances cecal intubation in unsedated patients with a history of abdominal surgery

Abstract

Background: colonoscopy in unsedated patients in the Us is considered to be difficult. success rate of cecal intubation is limited by discomfort. colonoscopy in patients with a history of abdominal surgery is also considered to be difficult due to adhesion-related bowel angulations. The water method has been shown to significantly reduce pain during colonoscopy. Objective: To test the hypothesis that the water method enhances the completion of colonoscopy in unsedated patients with a history of abdominal surgery. Design: The data bases of two parallel RcT were combined and analyzed. Setting: Two Veterans affairs endoscopy units. Patient and Methods:The water and air methods were compared in these two parallel RcT examining unsedated patients. Those with a history of abdominal surgery were selected for evaluation. Main Outcome Measurements: completion of unsedated colonoscopy. Results: among patients with a history of abdominal surgery, the proportion completing unsedated colonoscopy in the water group (19 of 22) was significantly higher than that (11 of 22) in the air group (p=0.0217, Fisher's exact test). Limitations: small number of predominantly male veterans, unblinded colonoscopists, not all types of abdominal surgery (e.g. hysterectomy, gastrectomy) predisposing to difficult colonoscopy were represented. Conclusion: This proof-of-principle assessment confirms that in patients with a history of abdominal surgery the water method significantly increases the proportion able to complete unsedated colonoscopy. The water method deserves to be evaluated in patients with other factors associated with difficult colonoscopy.

A Patient-Blinded Randomized, Controlled Trial Comparing Air Insufflation, Water Immersion, and Water Exchange During Minimally Sedated Colonoscopy

“…WE salvaged most of the failures (14 / 19), which is consistent with recent studies showing that WE provided salvage cecal intubation ( 1 ) and enhanced the success rate of cecal intubation in potentially diffi cult colonoscopy ( 12,33 ). Furthermore, when examining diffi culties in colonoscopy, the challenges can be divided into those that are right-sided or associated with redundancy and those that are left -sided or associated with " tight angles " ( 34 ).…”

Water-aided colonoscopy: a systematic review

“…The emerging interest in water-aided methods for colonoscopy is suggested by recent RCTs, 2,7-17 observational studies, 4,5,18,19 retrospective reports, 6,10,20-25 commentaries, [26][27][28][29][30][31][32][33][34] hypothesis papers, 35 editorials, [35][36][37][38] and reviews. [39][40][41][42][43] Water immersion entails distention of the colon by infused water, which is removed predominantly during withdrawal.…”

Alternatives to Incomplete Colonoscopy

“…Another technique that has been used in patients who have had previous surgery or those with redundant colons is the use of water immersion instead of air insufflation; inserting water at the start of the colonoscopy and suctioning air lead to decreased colonic distention, and the colon becomes shorter and straighter [21•]. A study comparing the water immersion technique vs. air insufflation in 44 unsedated patients with prior abdominal surgery noted a higher rate of cecal intubation with water immersion (86 vs. 50 %, respectively; p = 0.0217) [22]. Another study of 345 patients examined whether water immersion decreased the need for ancillary equipment to achieve cecal intubation in patients with previous incomplete colonoscopy.…”