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Water exchange superior at reducing insertion pain during colonoscopy
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Water exchange was superior to water immersion and air insufflation in reducing insertion pain in patients who underwent minimally sedated colonoscopy in a recent head-to-head comparative trial.
Researchers conducted a prospective masked trial of 270 patients undergoing colonoscopic screening, surveillance or diagnostic examination at Buddhist Dalin Tzu Chi Hospital in Taiwan from February 2012 to March 2013. Patients were randomly assigned to one of three groups of 90 based on insertion method: water immersion (WI), with instilled water suctioned back on withdrawal; water exchange (WE), with instilled water suctioned back during insertion; or air insufflation (AI).
Comparative effectiveness was primarily based on the proportion of patients who reported painless insertion (0-10 scale) although pain scores were obtained at 2- to 3-minute intervals throughout the procedure and at withdrawal.
The proportion of patients who reported painless insertion with AI was 30%, WI 43.3% and WE 61.1% (P<.001). WE rates were greater than WI (P=.0249) and AI (P=.0001). Likewise, after adjusting for sex, BMI, abdominal compression, position change, insertion time to cecum and length of scope at cecum, only WE was superior in terms of painless insertion compared with AI (OR=0.08; 95% CI, 0.03-0.24) and WI (OR=0.14; 95% CI, 0.05-0.4).
An “intriguing” trend of greater adenoma detection rate (ADR) in the right colon also was observed with WE (26.7%) compared with AI (11%) and WI (14.4%; P=.015). Pain scores at withdrawal were similar for all groups.
“When attenuated insertion pain is desirable,” the researchers concluded, “and when increased ADR in the right colon is needed … replacing AI with WE as the preferred modality to aid colonoscope insertion deserves consideration.”
Disclosure: The researchers report no relevant financial disclosures.
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