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Water Exchange Increases ADR During Screening Colonoscopy
Water exchange, but not water immersion, led to significantly higher adenoma detection rates compared with air insufflation during screening colonoscopy, according to the results of a randomized controlled trial.
“In a European population of screening patients, water exchange was associated with higher overall ADR, right colon ADR and advanced ADR, as well as entire colon [mean adenomas per procedure]. Water exchange further improved colon cleanliness after split-dose bowel preparation,” investigators wrote. “Our findings may be relevant in addressing the issue of missed adenomas, particularly in the cecum and the ascending colon.”
Water immersion involves infusing water to facilitate cecal intubation, limiting insufflation and removing residual water mostly during withdrawal. Water exchange involves gasless insertion to the cecum in clear water with minimal distension and maximal cleanliness during insertion.
To compare the ADRs achieved using air insufflation and both types of water-aided colonoscopy techniques, investigators randomly assigned 1,224 patients at three endoscopy centers to undergo screening colonoscopy using one of the three strategies.
All patients received a split-dose bowel preparation, and a second colonoscopist masked to the insertion technique completed the withdrawal after a different colonoscopist reached the cecum.
Water exchange resulted in significantly higher overall ADR compared with air insufflation (49.3% vs. 40.4%; P = .03), and similar overall ADR compared with water immersion (43.4%).
In addition, water exchange resulted in significantly higher ADR in the right colon compared with air insufflation (24% vs. 16.9%; P = .04), and also a higher advanced ADR (6.1% vs. 2.5%; P = .03) and a higher mean number of adenomas per procedure (P = .04).
Water exchange also resulted in the best cleanliness scores overall and in the right colon, which were similar between water immersion and air insufflation techniques. Adverse events were comparable between all groups.
“The design with blinded colonoscopists strengthens the validity of the observation that water exchange, but not water immersion, can achieve significantly higher adenoma detection than air insufflation,” the researchers concluded. “Based on this evidence, the use of water exchange should be encouraged.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.