Water exchange colonoscopy decreased adenoma miss rates compared with literature data and local data with CO2 insufflation: an observational study

Chi-Liang Cheng, Yen-Lin Kuo, Yu-Hsi Hsieh, Jui-Hsiang Tang, Felix W Leung, Chi-Liang Cheng, Yen-Lin Kuo, Yu-Hsi Hsieh, Jui-Hsiang Tang, Felix W Leung

Abstract

Background: Reports showed adenoma miss rates (AMRs) of 22.5-27% in the right colon and 23.4-33.3% in the proximal colon. Missed lesions could contribute to postcolonoscopy cancers. Water exchange (WE) with near-complete removal of infused water during insertion increased adenoma detection rate but the impact on AMR had not been reported. We hypothesized that WE could reduce AMRs. Study 1 compared the AMRs of WE with literature data. Study 2 developed local AMR data with CO2 insufflation.

Methods: The lead author attended a research seminar in 2017 on WE colonoscopy. For performance improvement, study 1 was undertaken. When data in study 1 confirmed WE produced a considerably lower AMRs in the right and proximal colon, study 2 with CO2 insufflation was performed.

Results: Eighty-six patients completed each study. In study 1, WE removed 89% of infused water upon arrival to the cecum. The AMRs of right colon (17.5%) and proximal colon (15.5%) were considerably lower than those in the literature. Upon completion of study 2, compared with local data of CO2 insufflation, WE showed a significantly lower AMR in the right (17.5% vs. 33.8%, P = 0.034) and proximal (15.5% vs. 30.4%, P = 0.018) colon, respectively. The major limitation was that the investigation consisted of two consecutive observational studies, not a randomized controlled trial (RCT).

Conclusions: WE with near-complete (89%) removal of infused water during insertion significantly decreased AMRs in the right and proximal colon compared with literature data and those of CO2 insufflation in our hands. The provocative data warrant confirmation in a RCT.

Trial registration: NCT03832322 (Retrospectively registered on February 2, 2019).

Keywords: Adenoma miss rate; Carbon dioxide; Colon polyp; Colonoscopy; Water exchange.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study 1 (the WE group). Abbreviation: ASA American Society of Anesthesiology, WE water exchange.
Fig. 2
Fig. 2
Flow chart of study 2 (the CO2 group)

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Source: PubMed

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