A pilot study to assess feasibility of the water method to aid colonoscope insertion in community settings in the United States

Abstract

Background:The water method decreases patient discomfort and sedation requirement. applicability in non-veteran community settings in the United states (U.s.) has not been reported. Aims: Our aim is to perform a pilot study to establish feasibility of use the water method at 2 community sites. We tested the hypothesis that compared with air insufflation patients examined with the water method would require less sedation without adverse impact on outcomes. Methods: Two performance improvement projects were carried out. consecutive patients who consented to respond to a questionnaire after colonoscopy were enrolled. project 1: The design was single-blinded (patient only); quasirandomized -odd days (water), even days (air). colonoscopy was performed by a staff attending. project 2: a supervised trainee performed the reported procedures. In both, patient demographics (age, gender and body mass index), amount of sedation required during colonoscopy and procedure-related variables were recorded. The patients completed a questionnaire that enquired about discomfort during colonoscopy and willingness to repeat the procedure within 24 hours after the procedure. Results: project 1: significantly lower doses of fentanyl and midazolam were used and a higher adenoma detection rate (aDR) was demonstrated in the water group. project 2: 100% cecal intubation rate was achieved by the supervised trainee. Conclusion: This is the first pilot report in the U.s. documenting feasibility of the water method as the principal modality to aid colonoscope insertion in both male and female community patients. In a head-to-head comparison, significant reduction of sedation requirement is confirmed as hypothesized. No adverse impact on outcomes was noted.

Water exchange method for colonoscopy: Learning curve of an experienced colonoscopist in a U.S. community practice setting

“…Adherence to procedure times is possible with realistic scheduling. Our data are consistent with the findings in other community practice settings in the United States 20 and overseas. 21…”

Is water exchange superior to water immersion in detecting adenomas during colonoscopies? Results from a Bayesian network meta-analysis

“…The studies were published between 2009 [ 32 ] and 2017 [ 13 , 14 , 33 ]. Study population sizes ranged from 23 [ 34 ] to 3303 [ 13 ], and 11464 patients were included in total, which equated to 1998 patients in the WI group, 3778 patients in the WE group, 4431 patients in the AI group, and 696 patients in the CO 2 group. The proportion of male patients ranged from 30.4% [ 34 ] to 100% [ 31 ], and the mean patient age varied from 51.1 [ 35 ] to 69 [ 34 ] years in the WI group, 36 [ 36 ] to 65.6 [ 27 ] years in the WE group, 40.2 [ 36 ] to 67 [ 34 ] years in the AI group, and 54.3 [ 26 ] to 63.1 [ 27 ] years in the CO 2 group.…”

“…In 18 studies evaluating the ADR [ 13 , 14 , 27 , 29 – 31 , 34 , 37 – 47 ], these rate ranged from 25% [ 46 ] to 54.5% [ 34 ] in the WI group, 18.3% [ 13 ] to 67.5% [ 27 ] in the WE group, 13.3% [ 13 ] to 46% [ 41 ] in the AI group, and 26.5% [ 30 ] to 57.8% [ 27 ] in the CO 2 group. Of 27 studies evaluating pain scores [ 13 , 26 – 40 , 42 – 52 ], 13 studies evaluated the mean pain score [ 27 , 29 – 32 , 34 – 36 , 40 , 44 , 46 , 50 , 52 ], which ranged from 1.3 [ 32 ] to 4.1 [ 31 , 35 , 50 ] in the WI group, 1.3 [ 29 ]to 4.3 [ 27 ] in the WE group, 2.3 [ 29 , 30 ] to 6.4 [ 35 ] in the AI group, and 2 [ 30 ] to 4.8 [ 27 ] in the CO 2 group, whereas 14 studies evaluated the maximum pain score [ 13 , 26 , 28 , 33 , 37 – 39 , 42 , 43 , 45 , 47 – 49 , 51 ], which ranged from 2.3 [ 43 ] to 4 [ 49 ] in the WI group, 1.1 [ 28 ] to 3.3 [ 33 ] in the WE group, 2.9 [ 28 ] to 5.7 [ 26 ] in the AI group, and 2.9 [ 26 ] to 4.7 […”

“…Of 27 studies evaluating pain scores [ 13 , 26 – 40 , 42 – 52 ], 13 studies evaluated the mean pain score [ 27 , 29 – 32 , 34 – 36 , 40 , 44 , 46 , 50 , 52 ], which ranged from 1.3 [ 32 ] to 4.1 [ 31 , 35 , 50 ] in the WI group, 1.3 [ 29 ]to 4.3 [ 27 ] in the WE group, 2.3 [ 29 , 30 ] to 6.4 [ 35 ] in the AI group, and 2 [ 30 ] to 4.8 [ 27 ] in the CO 2 group, whereas 14 studies evaluated the maximum pain score [ 13 , 26 , 28 , 33 , 37 – 39 , 42 , 43 , 45 , 47 – 49 , 51 ], which ranged from 2.3 [ 43 ] to 4 [ 49 ] in the WI group, 1.1 [ 28 ] to 3.3 [ 33 ] in the WE group, 2.9 [ 28 ] to 5.7 [ 26 ] in the AI group, and 2.9 [ 26 ] to 4.7 [ 33 ] in the CO 2 group. In 21 studies evaluating the willingness to repeat rate [ 13 , 14 , 26 , 28 , 32 , 34 , 35 , 38 – 40 , 42 – 52 ], this rate ranged from 72.4% [ 42 ] to 100% [ 34 , 38 , 52 ] in the WI group, 76% [ 39 ] to 100% [ …”

“…In 27 studies evaluating caecal intubation time [ 13 , 14 , 26 – 33 , 35 – 49 , 51 , 52 ], this timing ranged from 5.6 minutes [ 44 ] to 34 minutes [ 47 ] in the WI group, 6.9 minutes [ 41 ] to 17.5 minutes [ 52 ] in the WE group, 4.6 minutes [ 44 ] to 37 minutes [ 47 ] in the AI group, and 5 minutes [ 40 ] to 9.8 minutes [ 33 ] in the CO 2 group. In 22 studies evaluating total procedure time [ 14 , 26 , 30 – 37 , 39 – 49 , 51 ], the total timing ranged from 14 minutes [ 34 ] to 56 minutes [ 47 ] in the WI group, 15.7 minutes [ 36 ] to 29 minutes [ 39 ] in the WE group, 13.1 minutes [ 44 ] to 56 minutes [ 47 ] in the AI group, and 13 minutes [ 40 ] to 20.5 minutes [ 49 ] in the CO 2 group.…”