Comparative effectiveness of water immersion and water exchange versus air insufflation for colonoscopy.
J Interv Gastroenterol. 2013 7;3(3):100-103
Authors: Leung FW, Hu B, Wu J
INTRODUCTION: Water-aided colonoscopy can be categorized by the timing of removal of infused water, predominantly during withdrawal (water immersion) or during insertion (water exchange), respectively.
OBJECTIVE: To assess the impact of water immersion and water exchange on insertion pain and adenoma detection rate, when compared with air insufflation colonoscopy.
SETTING: Published randomized controlled trial (RCT) that compared water immersion or water exchange with air insufflation.
PATIENTS: Patients undergoing colonoscopy.
INTERVENTIONS: Medline, PubMed, Google searches (January 2008 to December 2011) to identify appropriate RCTs.
MAIN OUTCOME MEASUREMENTS: Pain during insertion phase and adenoma detection rate.
METHOD: Review Manager Software (Version 5.1, Cochrane Collaboration, UK).
RESULTS: Pain scores of both water-aided methods are lower than that of the air insufflation method. Subgroup analysis shows that compared with air insufflation, the water exchange group had a greater mean reduction of maximum pain during insertion -2.73 (-3.29, -2.18) than the water immersion group -1.31 (-1.64, -0.97). There is no significant difference in overall adenoma detection rate between water-aided methods and air insufflation. Subgroup analysis shows that compared with air insufflation, the water exchange group had higher adenoma detection rate, OR 1.52, (95%CI: 1.08-2.14) than the water immersion group, OR 0.92, (95%CI: 0.70-1.21).
LIMITATION: Unblinded colonoscopists exposed observations to uncertain bias.
CONCLUSION: Compared with air insufflation, the data presentation in a meta-analysis format show that both water immersion and water exchange significantly reduce insertion pain. Water exchange may be superior to water immersion in minimizing insertion pain and in increasing adenoma detection rate.
PMID: 24478928 [PubMed - as supplied by publisher]