Water-aided colonoscopy: a systematic review - 15/08/12

Doi : 10.1016/j.gie.2012.04.467

Felix W. Leung, MD ^1,^2,^⁎, Arnaldo Amato, MD ³, Christian Ell, MD, PhD ⁴, Shai Friedland, MD ^5,⁶, Judith O. Harker, PhD ¹, Yu-Hsi Hsieh, MD ⁷, Joseph W. Leung ^8,⁹, Surinder K. Mann ^8,⁹, Silvia Paggi, MD ³, Jürgen Pohl, MD, PhD ⁴, Franco Radaelli, MD ³, Francisco C. Ramirez, MD ¹⁰, Rodelei Siao-Salera, BSN CGRN ⁸, Vittorio Terruzzi, MD ³
¹ Research and Medical Services, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, Los Angeles, California, USA
² Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA
³ Division of Gastroenterology, Valduce Hospital, Como, Italy
⁴ Department of Gastroenterology, Dr Horst Schmidt Klinik, Wiesbaden, Germany
⁵ Gastroenterology Section, Palo Alto Veterans Affairs Medical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
⁶ Division of Gastroenterology, Stanford University, Stanford, California, USA
⁷ Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan
⁸ Section of Gastroenterology, Sacramento Veterans Affairs Medical Center, Veterans Affairs Northern California Health Care System, Mather, California, USA
⁹ Division of Gastroenterology and Hepatology, University of California, Davis Medical Center, Sacramento, California, USA
¹⁰ Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona, USA

Reprint requests: Felix W. Leung, MD, 111G, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, 16111 Plummer Street, North Hills, CA 91343

Résumé

Background

Water-aided methods for colonoscopy are distinguished by the timing of removal of infused water, predominantly during withdrawal (water immersion) or during insertion (water exchange).

Objective

To discuss the impact of these approaches on colonoscopy pain and adenoma detection rate (ADR).

Design

Systematic review.

Setting

Randomized, controlled trial (RCT) that compared water-aided methods and air insufflation during colonoscope insertion.

Patients

Patients undergoing colonoscopy.

Intervention

Medline, PubMed, and Google searches (January 2008-December 2011) and personal communications of manuscripts in press were considered to identify appropriate RCTs.

Main Outcome Measurements

Pain during colonoscopy and ADR. RCTs were grouped according to whether water immersion or water exchange was used. Reported pain scores and ADR were tabulated based on group assignment.

Results

Pain during colonoscopy is significantly reduced by both water immersion and water exchange compared with traditional air insufflation. The reduction in pain scores was qualitatively greater with water exchange as compared with water immersion. A mixed pattern of increases and decreases in ADR was observed with water immersion. A higher ADR, especially proximal to the splenic flexure, was obtained when water exchange was implemented.

Limitations

Differences in the reports limit application of meta-analysis. The inability to blind the colonoscopists exposed the observations to uncertain bias.

Conclusion

Compared with air insufflation, both water immersion and water exchange significantly reduce colonoscopy pain. Water exchange may be superior to water immersion in minimizing colonoscopy discomfort and in increasing ADR. A head-to-head comparison of these 3 approaches is required.

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Abbreviations : ADR, PEG, RCT

Plan

DISCLOSURE: The study was supported in part by Veterans Affairs Medical Research Funds at Veterans Affairs Greater Los Angeles Healthcare System and an American College of Gastroenterology Clinical Research Award (F.W.L). No other financial relationships relevant to this publication were disclosed.