Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations

Cadoni, Sergio; Ishaq, Sauid; Hassan, Cesare; Falt, Přemysl; Fuccio, Lorenzo; Siau, Keith; Leung, Joseph; Anderson, John T.; Binmoeller, Kenneth F.; Radaelli, Franco; Rutter, Matt; Sugimoto, Seiichiro; Muhammad, Humayun; Bhandari, Pradeep; Draganov, Peter V.; Groen, Piet de; Wang, Andrew Y.; Yen, Andrew W.; Hamerski, Chris M.; Thorlacius, Henrik; Neumann, Helmut; Ramirez, Francisco C.; Mulder, Chris J.J.; Albéniz, Eduardo; Amato, Arnaldo; Arai, Makoto; Bak, Adrian W.; Barret, Maximilien; Bayupurnama, Putut; Cheung, Ramsey; Ching, Hey Long; Cohen, Hartley; Dolwani, Sunil; Friedland, Shai; Harada, Hideaki; Hsieh, Yu Hsi; Hayee, Bu; Kuwai, Toshio; Lorenzo-Zúñiga, Vicente; Liggi, Mauro; Mizukami, Takeshi; Mura, Donatella; Nylander, David; Ólafsson, Snorri; Paggi, Silvia; Pan, Yanglin; Parra‐Blanco, Adolfo; Ransford, Rupert; Rodríguez-Sánchez, Joaquín; Şentürk, Hakan; Suzuki, Noriko; Tseng, Chih‐Wei; Uchima, Hugo; Uedo, Noriya; Leung, Felix W.

doi:10.1016/j.gie.2020.10.011

Cited by 38 publications

(42 citation statements)

References 60 publications

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“…A recent modified Delphi consensus conducted by experienced clinicians around the globe recognized WE significantly increased ADR in multiple RCTs. [34][35][36][37] The current report demonstrates that WE is also effective in improving SSA/PDR. This is not surprising as ADR and AADR are positively associated with SSA/PDR and WE had been shown to have superior ADR and AADR than traditional air insufflation, Endocuff, and cap colonoscopy in a previous meta-analysis.…”

Section: Discussionsupporting

confidence: 52%

Sessile serrated adenoma/polyp detection rate of water exchange, Endocuff, and cap colonoscopy: A network meta‐analysis

Shao

Romero

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Sessile serrated adenoma/polyp (SSA/P) may contribute to interval cancer. In a recent meta-analysis, water exchange (WE) was shown to be superior to Endocuff and cap colonoscopy at adenoma and advanced adenoma detection. The strong positive correlation between adenoma detection rate (ADR), advanced adenoma detection rate (AADR), and sessile serrated adenoma/polyp detection rate (SSA/PDR) prompted us to hypothesize that WE could significantly improve SSA/PDR compared with Endocuff and cap colonoscopy. Methods: The literature was searched for all randomized controlled trials (RCTs) that reported SSA/PDR as an outcome and included the keywords colonoscopy, and water exchange, Endocuff, or cap. We performed traditional network meta-analyses with random effect models comparing SSA/PDR of each method using air insufflation as the control and reported the odds ratios (ORs) with 95% confidence interval (CI). Performances were ranked based on P-score. Results: A total of 531 articles resulted from initial keywords search. Eleven RCTs were included in the analysis. A total of 7856 patients underwent air insufflation, WE, Endocuff, or cap colonoscopy. WE significantly increased SSA/PDR (OR 2.04; 95% CI 1.33-3.13). Endocuff (OR 1.15; 95% CI 0.94-1.41) and cap (OR 1.08; 95% CI 0.42-2.74) did not significantly impact SSA/P detection. P-scores for WE (0.96), Endocuff (0.49), cap (0.37), and air insufflation (0.17) suggested that WE had the highest SSA/PDR. The results did not change after adjusting for mean withdrawal time and indication for colonoscopy. Conclusion: Water exchange significantly increases SSA/PDR and is superior to Endocuff and cap colonoscopy at detecting SSA/P.

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Section: Discussionsupporting

confidence: 52%

Sessile serrated adenoma/polyp detection rate of water exchange, Endocuff, and cap colonoscopy: A network meta‐analysis

Shao

Romero

et al. 2021

J of Gastro and Hepatol

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“…A network meta-analysis concluded that WE produced the highest ADR when compared with water immersion and gas insufflation [ 41 ]. A modified Delphi review also endorsed WE as having better bowel cleanliness, as well as less insertion pain and higher ADRs, than gas insufflation [ 42 ].…”

Section: Water Exchange and Its Potential Beneficial Effect On Reducing Fpsmentioning

confidence: 99%

Computer-Aided Detection False Positives in Colonoscopy

et al. 2021

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Randomized control trials and meta-analyses comparing colonoscopies with and without computer-aided detection (CADe) assistance showed significant increases in adenoma detection rates (ADRs) with CADe. A major limitation of CADe is its false positives (FPs), ranked 3rd in importance among 59 research questions in a modified Delphi consensus review. The definition of FPs varies. One commonly used definition defines an FP as an activation of the CADe system, irrespective of the number of frames or duration of time, not due to any polypoid or nonpolypoid lesions. Although only 0.07 to 0.2 FPs were observed per colonoscopy, video analysis studies using FPs as the primary outcome showed much higher numbers of 26 to 27 per colonoscopy. Most FPs were of short duration (91% < 0.5 s). A higher number of FPs was also associated with suboptimal bowel preparation. The appearance of FPs can lead to user fatigue. The polypectomy of FPs results in increased procedure time and added use of resources. Re-training the CADe algorithms is one way to reduce FPs but is not practical in the clinical setting during colonoscopy. Water exchange (WE) is an emerging method that the colonoscopist can use to provide salvage cleaning during insertion. We discuss the potential of WE for reducing FPs as well as the augmentation of ADRs through CADe.

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“…An international modified Delphi review has defined water immersion in water-assisted colonoscopy. 10 With the development of CE research and applications, we can also provide an academic definition of water-assisted techniques.…”

Section: Disclosurementioning

confidence: 99%

“…Finally, we should consider aligning with relevant literature for the colon and establish (instead of the diving method) the term "water-immersion SB CE" for any future use of this approach. 10…”

mentioning

confidence: 99%

Diving method or simply…water-immersion small-bowel capsule endoscopy

Koulaouzidis

Dabos

Tóth

2021

Gastrointestinal Endoscopy

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and motor skill performance can be undertaken, 3 with potential incorporation into fellowship training programs. 9 Endoscopy units could consider mindfulness training to improve multidisciplinary collaboration and management of workplace negotiations and conflicts. On an individual or team level, gastroenterologists could briefly perform mindful breathing before a colonoscopy, similar to a safety timeout.Cultivating mindfulness has the potential to benefit individual performance and enhance relationships between physician, patient, and the healthcare team. Although endoscoping mindfully is a good step toward creating a more conscious and responsive system, institutions will need to commit resources to ensure these practices are sustainable.

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Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations

Cited by 38 publications

References 60 publications

Sessile serrated adenoma/polyp detection rate of water exchange, Endocuff, and cap colonoscopy: A network meta‐analysis

Sessile serrated adenoma/polyp detection rate of water exchange, Endocuff, and cap colonoscopy: A network meta‐analysis

Computer-Aided Detection False Positives in Colonoscopy

Diving method or simply…water-immersion small-bowel capsule endoscopy

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