Post written by Sergio Cadoni, MD, from the Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy.
Water exchange colonoscopy (WE) has been consistently shown to be the least painful insertion technique, decreasing the need for sedation and significantly increasing colon cleanliness and lesion detection. However, the wide adoption of WE has been hindered by the misconception that a longer insertion time when compared with air or carbon dioxide insufflation (collectively defined as GAS) would prolong total procedure time. In our study, we estimated the impact of WE colonoscopy on efficiency of room turnaround by assessing cecal intubation time and total procedure time. Demonstrating that WE does not have a negative impact on room turnaround might help promoting its use.
Our systematic review and meta-analysis included 17 randomized controlled trials. Compared with GAS, WE required about 3 to 4 additional minutes to reach the cecum, but total procedure time was only 1.6 minutes longer for WE. Interestingly, colonoscopists with expertise in WE took only 1 additional minute to complete the whole procedure. Patient-centered outcomes revealed that patients examined with WE had a significantly lower real-time insertion pain score, less need for sedation, and higher willingness to repeat the procedure.
WE colonoscopy yields an increase in total procedure time of about 1 to 2 minutes and is associated with significant improvement in specific patient-centered outcomes.
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