A randomized, controlled trial to confirm the beneficial effects of the water method on U.S. veterans undergoing colonoscopy with the option of on-demand sedation

Leung, Joseph; Mann, Surinder K; Siao-Salera, Rodelei; Ransibrahmanakul, Kanat; Lim, Brian; Canete, Wilhelmina; Samson, Laramie; Gutierrez, Rebeck; Leung, Felix W.

doi:10.1016/j.gie.2010.09.020

Cited by 91 publications

(127 citation statements)

References 42 publications

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“…In the water group, the dose of fentanyl was significantly lower and the lower dose of midazolam approached significance. 20 The findings in the above two RCT are being confirmed by several presentations at this meeting. One RCT from India 29 shows that water infusion significantly reduced the proportion of unsedated patients with pain score ≥2 (5 was most severe) compared with the air method (p<0.05).…”

supporting

confidence: 60%

DDW "Cutting Edge" Colonoscopy Techniques 2011 State-of-the-Art Lecture: Warm water infusion/CO2 insufflation for colonoscopy

Leung¹,

Leung²,

Mann³

et al. 2011

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supporting

confidence: 60%

DDW "Cutting Edge" Colonoscopy Techniques 2011 State-of-the-Art Lecture: Warm water infusion/CO2 insufflation for colonoscopy

Leung¹,

Leung²,

Mann³

et al. 2011

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“…Sedation as needed 24 is controlled by the colois controlled by the colonoscopist and on demand sedation 27,28 by the patients. As needed or on demand sedation starts out without pre-medications.…”

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confidence: 99%

“…In both instances, completion without sedation obviates sedation complications and the time burden associated with recovery -both on-site and at home. 28 The numbers at the bottom row of Table 2 depicts the proportion of patients who can complete without sedation based on the various options and the techniques used. When sedation as needed was described, only 6% required sedation.…”

mentioning

confidence: 99%

“…24 When on demand sedation was described a higher proportion completed without sedation when a water method was used compared with when the air method was used for inserting the colonoscope. 28 In scheduled unsedated patients, the water method offered a significantly higher success rate than the traditional air method. 30,31 Nurses who have worked with these options 32 considered the following as benefits of not using routine sedation.…”

mentioning

confidence: 99%

“…The cecum was then distended by air to confirm visualization of the ileocecal valve and the appendix orifice (cecal intubation). 27,28,30,31 In conclusion, the answer to the question "Is there a place for sedationless colonoscopy?" is "yes", when it is integrated into the various options to minimize patient burden in screening and surveillance colonoscopy.…”

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confidence: 99%

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Is there a place for sedationless colonoscopy?

Leung

2011

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REVIEW REVIEWUnsedated colonoscopy is available on a routine basis in many parts of the world.1 This paper will discuss the components of patient time burden of sedation, 2 tabulate the extent and significance of sedation-related complications 3 and review how various options without routine sedation impact these events in the context of colorectal cancer screening and surveillance. In the end we shall address the question in the title of this manuscript if there is a place for sedationless (unsedated) colonoscopy. Usedated colonoscopy is routinely available in many parts of the world. In the US, only educated professionals appear to be knowledgeable enough to request the unsedated option. Colonoscopists have also been willing to perform unsedated colonoscopy when a patient presents without an escort after undergoing bowel purge preparation. While the actual sideeffects of sedation are minimal, the escort requirement and time burden of sedation are barriers to the uptake of screening colonoscopy in the US. The recent trend of deep sedation with propofol for screening colonoscopy increases the efficiency of the colonoscopists at significant costs (e.g. anesthetist reimbursement). The options of as needed and on demand sedation permit patients to complete colonoscopy without sedation. The latter appears to be potentially less coercive. Nurses with experience in the unsedated options recognize the benefit of the quick turn-around of the examination room and shortened occupancy of the recovery area. Discharge planning can be optimized due to absence of amnesia. Patients completing unsedated colonoscopy have given their endorsement of the options. Pain and discomfort continue to limit the success rate of cecal intubation to about 80%. A recently described water method (warm water infusion in lieu of air insufflation combined with removal of all residual colonic air by suction and residual feces by water exchange) has the potential of decreasing procedural discomfort and enhancing cecal intubation in unsedated colonoscopy. The availability of the novel water method assures colonoscopists that high success rate of cecal intubation can be achieved in the unsedated patients.

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