The water method significantly enhances proximal diminutive adenoma detection rate in unsedated patients

Leung, Felix W.; Leung, Joseph; Siao-Salera, Rodelei; Mann, Surinder K

doi:10.4161/jig.1.1.14587

Cited by 26 publications

(29 citation statements)

References 38 publications

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“…5 New challenges have also emerged and reviewed in recent reports of impact of the water method on adenoma detection. 6,7 Post screening colonoscopy interval cancers are likely due to missed lesions. Proximal colon cancer mortality is not reduced by screening colonoscopy or is reduced at best by only ~50% (in contrast to 80% to 90% in the distal colon).…”

Section: Biographymentioning

confidence: 99%

DDW "Cutting Edge" Colonoscopy Techniques 2011 State-of-the-Art Lecture: Warm water infusion/CO2 insufflation for colonoscopy

Leung¹,

Leung²,

Mann³

et al. 2011

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Section: Biographymentioning

confidence: 99%

DDW "Cutting Edge" Colonoscopy Techniques 2011 State-of-the-Art Lecture: Warm water infusion/CO2 insufflation for colonoscopy

Leung¹,

Leung²,

Mann³

et al. 2011

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“…The results of the current report indicate chromoendoscopy added to the water method is feasible showing an ADR of 62%. The salvage cleansing effect of the water exchange, which is an integral part of the water method 4,8 obviated the need to exclude any patients because of poor bowel preparation even when indigo carmine was added to the water. The water with indigo carmine could provide cleansing of the colon with suboptimal bowel preparation.…”

Section: Discussionmentioning

confidence: 99%

“…Since the water method [1][2][3][4][5][6][7][8][9] and use of chromoendoscopy [10][11][12][13][14] were reported to have beneficial impacts, a performance improvement project evaluating their utility was carried out at the Sacramento VA Medical Center in Mather, California. Data were collected prospectively to monitor performance and analyzed retrospectively.…”

Section: Methodsmentioning

confidence: 99%

“…The water method has recently been reported to be superior to air method [1][2][3][4][5][6][7][8][9] , produces less sedation medication requirement in the sedated veterans [1][2][3] , and minimizes discomfort and enhances cecal intubation in the unsedated veterans [4][5][6] . Retrospective review of data in sedated veterans showed that the water method increased adenoma detection rate (ADR).…”

Section: Introductionmentioning

confidence: 99%

“…7 The pooled data of two RCT in predominantly unsedated veterans showed that the water method increased proximal diminutive adenoma detection. 8 Chromoendoscopy with pan colonic or targeted dye sprays has been shown to improve detection of colonic lesions. [10][11][12] Chromoendoscopy may be important also in the detection of non-polypoid colorectal neoplasms.…”

Section: Introductionmentioning

confidence: 99%

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The water method combined with chromoendoscopy enhances adenoma detection

Leung¹,

Ransibrahmanakul²,

Toomsen³

et al. 2011

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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.

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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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The water method significantly enhances proximal diminutive adenoma detection rate in unsedated patients

Cited by 26 publications

References 38 publications

DDW "Cutting Edge" Colonoscopy Techniques 2011 State-of-the-Art Lecture: Warm water infusion/CO2 insufflation for colonoscopy

DDW "Cutting Edge" Colonoscopy Techniques 2011 State-of-the-Art Lecture: Warm water infusion/CO2 insufflation for colonoscopy

The water method combined with chromoendoscopy enhances adenoma detection

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

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