Insertion water exchange increases right colon adenoma and hyperplastic polyp detection rates during withdrawal

Cadoni, Sergio; Falt, Přemysl; Sanna, Stefano; Argiolas, Mariangela; Fanari, Viviana; Gallittu, Paolo; Liggi, Mauro; Mura, Donatella; Porcedda, M.L.; Smajstrla, Vit; Erriu, Matteo; Leung, Felix W.

doi:10.1016/j.dld.2016.03.004

Cited by 10 publications

(22 citation statements)

References 51 publications

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“…A total of 12 studies with 17 arms were included in the final analysis for this systematic review and meta-analysis ( Fig. 1) [23][24][25][26][27][28][29][30][31][32][33][34]. Of these, all were RCTs except one cohort study [32].…”

Section: Resultsmentioning

confidence: 99%

“…Nine of these studies were published as full manuscripts and 2 were published as abstracts. Two studies by Cadoni et al included data from the same RCT and hence we only included data once while comparing outcomes [26,27].…”

Section: Resultsmentioning

confidence: 99%

“…Study details and demographics of patients are summarized in Supplementary Table 3 and Table 1. Of all the studies included, 11 directly compared ACI to WE [23][24][25][26][27][28][29][30][31][32][33][34] and 4 directly compared ACI to WI [26,28,30,34]. The total number of patients included in these 11 studies was 5660 (2260 ACI, 2281 WE, 1119 WI).…”

Section: ) or Egger's Regression Test (P=034)mentioning

confidence: 99%

“…Hsieh et al [34] Hsieh et al [30] Cadoni et al [26,27] Leung et al [24] Leung et al [23] Ramirez et al [31] Hsieh et al [34] Hsieh et al [30] Cadoni et al [26,27] Cadoni et al [29] Boroff et al [32] Overall (I^2=43.52 % , P= 0.088) 1 (Fig. 2B).…”

Section: Studiesmentioning

confidence: 99%

“…PADROverall, 8 studies reported PADR[23,24,27,[29][30][31][32]34]. The 8 arms comparing WE to ACI revealed a higher PADR for the WE group (WE: 29.7%, 95%CI 21.8-41.9% vs. ACI: 23.2%, 95%CI 14.1-33.8%; RR 1.30, 95%CI 1.11-1.53; P=0.001; I 2 =43.5%) (Fig.…”

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: ) or Egger's Regression Test (P=034)mentioning

confidence: 99%

Section: Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

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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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The impact of water‐aided methods on pain reduction and adenoma detection rate during colonoscopy

Hsieh

Leung

2018

Adv in Digestive Medicine

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With the nationwide colorectal cancer screening program in place in Taiwan, there is an urgent need to promote techniques with a positive impact on adenoma detection rate (ADR) to minimize the risk of interval cancers. Despite widespread use of sedation, many patients in Taiwan still undergo unsedated or minimally sedated colonoscopy. Techniques that minimize pain will enhance the experience of colonoscopy, and facilitate participation in screening and surveillance. A review of water‐aided colonoscopy is appropriate at this time. Water exchange (WE), in particular, appears to be able to meet the needs of colonoscopy patients in Taiwan. Water‐aided methods are distinguished into water immersion (WI) and WE by the timing of removal of infused water—WI during withdrawal and WE during insertion. Both methods are typically performed with air pump turned off during the insertion phase of colonoscopy and thus are reported to produce less insertion pain as compared with traditional air insufflation (AI). Some colonoscopists do not require air exclusion with WI. The removal of water during insertion phase of colonoscopy, coupled with suctioning of residual air pockets, further enhance the pain reduction by WE. Head‐to‐head comparison of AI, WI, and WE has shown that WE reduced insertion pain to a greater extent than WI. Recent studies also showed that WE produced less insertion pain, with more patients completing colonoscopy without pain as compared with carbon dioxide (CO2) insufflation. WE also provides salvage cleaning during insertion and reduces distraction to inspection during withdrawal, both of which might help the colonoscopist to find more polyps. In recent randomized controlled trials comparing AI, WI, and WE, the secondary outcomes of overall ADR and right colon or proximal colon ADR were in favor of WE, but not WI. In conclusion, with practice WE is an easy and inexpensive way of insertion during colonoscopy. Its ability to reduce insertion pain and increase ADR may help improve the quality of colonoscopy. Colonoscopists in Taiwan should consider contributing to a study to assess whether the increase in ADR by WE is reproducible, and if so, whether the occurrence of interval cancers can be reduced or avoided.

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Comparing right colon adenoma detection rate during water exchange and air insufflation: a double-blind randomized controlled trial

et al. 2021

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Insertion water exchange increases right colon adenoma and hyperplastic polyp detection rates during withdrawal

Cited by 10 publications

References 51 publications

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

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

The impact of water‐aided methods on pain reduction and adenoma detection rate during colonoscopy

Comparing right colon adenoma detection rate during water exchange and air insufflation: a double-blind randomized controlled trial

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