Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies

Fuccio, Lorenzo; Frazzoni, Leonardo; Hassan, Cesare; Marca, Marina La; Paci, Valentina; Smania, Veronica; Bortoli, Nicola de; Bazzoli, Franco; Repici, Alessandro; Rex, Douglas K.; Cadoni, Sergio

doi:10.1016/j.gie.2018.06.028

Cited by 77 publications

(90 citation statements)

References 46 publications

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“…A systematic review by Fuccio et al 3 appears to confirm these findings. They looked at 17 randomised controlled trials in which a total of 10 350 patients underwent WE, WI or gas insufflation colonoscopy.…”

Section: Water Exchange Colonoscopy: Crystal Clear Benefit?mentioning

confidence: 81%

Highlights from the literature

McGowan

Dunne

2018

Frontline Gastroenterol

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Section: Water Exchange Colonoscopy: Crystal Clear Benefit?mentioning

confidence: 81%

Highlights from the literature

McGowan

Dunne

2018

Frontline Gastroenterol

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“…The exact mechanism through which WE improves colonoscopy outcome metrics, such as ADR, RADR and PADR, is not fully understood. One possible theory points to the greater cleanliness throughout the colon achieved through simultaneous water infusion and suction in the WE method, as shown by Fuccio et al [8]. Another possible mechanism is the magnifying effect of water itself on the endoscope optics during the insertion phase, leading to higher detection rates [34].…”

Section: Discussionmentioning

confidence: 97%

“…An increase in ADR has been strongly linked to a decrease in the incidence of colorectal cancer (CRC) and subsequent mortality [7]. Fuccio et al compared the WE, WI and ACI methods in a comparative meta-analysis and demonstrated the superiority of the WE method over both WI and ACI in terms of overall adenoma detection rate and right colon adenoma detection rate (RADR) [8]. Another network meta-analysis by Facciorusso et al supported the use of water techniques for improving overall ADR [9].…”

Section: Introductionmentioning

confidence: 99%

How to increase proximal adenoma detection rate: a meta-analysis comparing water exchange, water immersion and air/CO2 insufflation methods for colonoscopy

Aziz

Sharma

Fatima

et al. 2020

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BackgroundRecent meta-analyses have demonstrated a higher adenoma detection rate using the water exchange method (WE), compared to water immersion (WI) and air/CO 2 insufflation (ACI). Proximal adenomas have a high miss rate owing to their location and appearance. We performed a systematic review and meta-analysis of studies comparing the WE and WI methods to the ACI method, with a primary focus on proximal adenoma detection rate. MethodsThe following databases were searched for our systematic review: Medline, Embase, Cochrane Library, CINAHL, and Web of Sciences. We included both randomized controlled trials and cohort studies. The primary outcome was proximal adenoma detection rate, and secondary outcomes were right adenoma detection rate and cecal intubation rate.Results A total of 12 studies (17 arms) with 5660 patients (2260 ACI, 2281 WE, and 1119 WI) were included. A higher proximal adenoma detection rate (risk ratio [RR] 1.30, 95% confidence interval [CI] 1.11-1.53; P=0.001) and right adenoma detection rate (RR 1.43, 95%CI 1.19-1.71; P≤0.001; I 2 =0%) were noted for the WE group compared to the ACI group. The WI group did not demonstrate a better detection rate of proximal or right adenomas. ConclusionsThe water exchange method for colonoscopy holds promise and should be encouraged in the clinical setting to increase proximal and right adenoma detection rates. This will in turn decrease the incidence of colorectal cancer.

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“…The latter causes bloating and related abdominal pain, which also may affect patients after the procedure. Compared with air insufflation colonoscopy (AIR), CO 2 insufflation produces significantly less bloating and pain in the post-procedure period [8,9], but has been reported to be ineffective in decreasing pain during instrument insertion in patients undergoing unsedated colonoscopy or in procedures with different approaches to sedation [10] performed by experienced colonoscopists.…”

Section: E986mentioning

confidence: 99%

Covid-19 pandemic impact on colonoscopy service and suggestions for managing recovery

et al. 2020

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Background and aim As the post-peak phase of the epidemic is approaching, there is an urgent need of an action plan to help resume endoscopy activity. To manage the Covid-19 pandemic-imposed backlog of postponed colonoscopy examinations, an efficient approach is needed. The practice of on-demand sedation with benzodiazepines and/or opiates will allow most patients to complete a water-aided examination with minimal or no sedation. Other methods reported to minimize patient discomfort during colonoscopy can be used, in addition to water-aided techniques. Unsedated or minimally sedated patients who do not require recovery or require a shorter one allow rapid turnaround. The practice obviates the need for assistance with deep sedation from anesthesiologists, who may be in short supply. Trainee education in water-aided colonoscopy has been demonstrated to confer benefits. This review provides some insights into the impact of Covid-19 on endoscopy services, challenges ahead, and possible solutions to help recovery of colonoscopy work and training.

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Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies

Abstract: WE significantly increases overall ADR, ADR in screening cases, and in the right side of the colon; it also improves colon cleanliness but requires a longer insertion time.

Cited by 77 publications

References 46 publications

Highlights from the literature

Highlights from the literature

How to increase proximal adenoma detection rate: a meta-analysis comparing water exchange, water immersion and air/CO2 insufflation methods for colonoscopy

Covid-19 pandemic impact on colonoscopy service and suggestions for managing recovery

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