title: A new water instillation method for colonoscopy without sedation as performed by endoscopists-in-training.
abstract: BACKGROUND
  Colonoscopy may be associated with discomfort when performed without sedation. A study was conducted to determine whether instillation of water into the colon at the beginning of the procedure reduces intubation time as well as patient discomfort and pain.
  
  
  METHODS
  Colonoscopy was performed in 259 patients by 3 endoscopists-in-training with limited experience. Patients were randomly allocated to 2 groups. In one, a technique was used in which 500 to 1000 mL of water is instilled into the colon by enema at the beginning of the procedure (instillation group, n = 130). In the other, patients underwent a conventional colonoscopy (control group, n = 129). Intubation time was measured and compared between the groups, and subjective discomfort experienced by the patients was measured upon completion of the examination.
  
  
  RESULTS
  Success rates for insertion to the cecum were similar, (95.4%, instillation group; 96.1%, control group). Detection rates for any colorectal diseases were not different between the groups (30.0% vs. 32.6%). Mean time to cecal intubation was 10.5 minutes in the instillation group and 16.2 minutes in the control group (p < 0.0001). The proportion of patients who complained of abdominal pain during the procedure was 17.1% in the instillation group and 33.3% in the control group (p < 0.001).
  
  
  CONCLUSIONS
  When used by endoscopists-in-training, the water-instillation colonoscopy technique was associated with less discomfort and faster cecal intubation with no decrease in the rate of detection of colorectal diseases.
authors.affiliation: Department of Gastroenterology, Hirata Municipal Hospital, Japan.
authors.forename: Naoharu
authors.initials: N
authors.lastname: Hamamoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakanishi
authors.forename: Naofumi
authors.initials: N
authors.lastname: Morimoto
authors.forename: Harue
authors.initials: H
authors.lastname: Inoue
authors.forename: Masashi
authors.initials: M
authors.lastname: Tatukawa
authors.forename: Shuji
authors.initials: S
authors.lastname: Nakata
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Kawai
authors.forename: Naoko
authors.initials: N
authors.lastname: Kurihara
authors.forename: Souhei
authors.initials: S
authors.lastname: Ookuchi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Shizuku
authors.forename: Shyun
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Sachiko
authors.initials: S
authors.lastname: Hamamoto
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kazumori
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003113:Colonoscopy / Q000379:methods*; D016292:Procedural Sedation; D004733:Enema / Q000379:methods*; D005260:Female; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D017211:Treatment Failure; D014867:Water / Q000008:administration & dosage
chemical_list: D014867:Water