Post written by Jen-Hao Yeh, MD, and Hsi-Yuan Chien, MD, from the Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital/I-shou University, Kaohsiung, and the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan.

Water colonoscopy is very useful to reduce pain and facilitate intubation for difficult colons. Water exchange method, by using water to fill the lumen while eliminating the air, has been shown to work better than simple infusion, and it may also enhance the adenoma detection rate. However, the requirement with a water pump and relative longer intubation time revealed by clinical trials might limit further widespread acceptance.

In this video, we demonstrated the minimal water exchange method that used the air-water valve button, instead of the pump, to infuse a small amount of water during intubation. By eliminating the air as in water exchange method, modest water infusion is enough to help endoscope advancement. In contrast to the original technique, we only suck dirty water with severely impaired visibility, and air insufflation is generally restarted upon entering the transverse colon. In this way, we can preserve the advantage of water colonoscopy without a need for any additional equipment, and the intubation time was not prolonged because of repeated water infusion and suction, as in the original water exchange method.

We have incorporated the minimal water exchange method into our daily practice. Although we believe it is an easy and useful method, further research is needed to compare its efficacy in pain score and adenoma detection rate compared to the original water exchange method because significantly less water (estimated 1/10) was used for irrigation during intubation. We hope this technique can be tried by more endoscopists and benefit more patients.

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