Water exchange versus carbon dioxide insufflation in unsedated colonoscopy: a multicenter randomized controlled trial

Garborg, Kjetil; Lindenburger, Wolfgang; Wiig, Håvard; Hasund, Audun; Wrońska, Ewa; Bie, R; Kleist, Britta; Løvdal, Leif; Holme, Øyvind; Kalager, Mette; Hoff, Geir; Bretthauer, Michael

doi:10.1055/s-0034-1390795

Cited by 40 publications

(56 citation statements)

References 24 publications

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“…Recent publications have suggested that WE produced the lowest insertion pain. 1,2,4,5,[9][10][11] Our current data (Tables 1 and 2) confirm these observations. The WE technique reproducibly achieved the lowest insertion pain not only in men, but also in women (Table 3), who usually report more pain during colonoscopy.…”

Section: Q16supporting

confidence: 84%

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Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy

Cadoni¹,

Falt²,

Gallittu³

et al. 2015

Clinical Gastroenterology and Hepatology

101

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Section: Q16supporting

confidence: 84%

“…[4][5][6] The description of water-aided methods varies in previously published studies. How these are used in actual practice is unknown.…”

Section: Q16mentioning

confidence: 99%

Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy

Cadoni¹,

Falt²,

Gallittu³

et al. 2015

Clinical Gastroenterology and Hepatology

101

View full text Add to dashboard Cite

“…47 A recent, randomized, single-blind study compared CO 2 insufflation (n Z 226) with water infusion (n Z 226) during colonoscope insertion, with all patients undergoing insufflation with CO 2 during colonoscope withdrawal. 45 Colonoscopy was initiated without sedation, but "on demand" sedation was administered as necessary to patients. The study indicated no difference in the eventual need for sedation medications between both groups.…”

Section: Clinical Experiencementioning

confidence: 99%

The use of carbon dioxide in gastrointestinal endoscopy

Lo¹,

Fujii-Lau²,

Enestvedt³

et al. 2016

Gastrointestinal Endoscopy

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“…The successful intubation rate without sedation with traditional air insufflation (AI) varied widely from 34% to 94%. 5,10,11 The on-demand sedation option has certain advantages over full sedation. The completion rates without sedation were generally higher with WE, ranging from 78% to 94%.…”

Section: Introductionmentioning

confidence: 99%

“…The completion rates without sedation were generally higher with WE, ranging from 78% to 94%. 5,10,11 The on-demand sedation option has certain advantages over full sedation. Use of sedation is associated with a small but real risk of cardiopulmonary complications.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Hsieh

Tseng

Koo

et al. 2019

J of Gastro and Hepatol

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Background and Aim Completion of colonoscopy without sedation eliminates sedation cost and complications. Reported in the United States and Europe, on‐demand sedation is not routine practice in Taiwan. Water exchange (WE), characterized by infusion and nearly complete removal of infused water during insertion, reduces insertion pain compared to air insufflation (AI) during colonoscopy. We evaluated the feasibility of on‐demand sedation in Taiwan. In a randomized controlled trial of WE vs AI colonoscopy, we also aimed to determine if WE augmented the implementation by reducing insertion pain and decreasing sedation requirement. Methods This prospective patient‐blinded study randomized patients to AI or WE (75 patients/group) to aid insertion. The primary outcome was the proportion of patients completing without sedation. Results In the AI and WE groups, 76.0% and 93.3% (P = 0.006) completed without need for sedation, respectively. The WE group had lower insertion pain score (mean [SD]) (4.0 [2.9] vs 2.1 [2.6], P < 0.001), lower doses of propofol (25.7 [52.7] mg vs 9.1 [35.6] mg, P = 0.012), and less time in the recovery room (3.4 [7.4] vs 1.5 [5.5], P = 0.027) than the AI group. Patient satisfaction scores and willingness to repeat if needed in the future were similar. Conclusion On‐demand sedation was feasible in Taiwan. The completion rate without sedation was high in patients (76.0% with standard AI) open to the option (no prior intent to receive the standard of full or minimal sedation). WE augmented the implementation by reducing insertion pain and decreasing sedation requirement without adversely affecting patient satisfaction or willingness to repeat.

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Water exchange versus carbon dioxide insufflation in unsedated colonoscopy: a multicenter randomized controlled trial

Abstract: There was no significant reduction in moderate or severe pain in a comparison of water exchange with CO2 insufflation. The secondary outcome of no pain was significantly more frequent in the water exchange group. Clinical trials registry number: NCT01633333.

Cited by 40 publications

References 24 publications

Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy

Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy

The use of carbon dioxide in gastrointestinal endoscopy

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

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