A new water instillation method for colonoscopy without sedation as performed by endoscopists-in-training.
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.
Hamamoto
Naoharu
N
Department of Gastroenterology, Hirata Municipal Hospital, Japan.
Nakanishi
Yutaka
Y
Morimoto
Naofumi
N
Inoue
Harue
H
Tatukawa
Masashi
M
Nakata
Shuji
S
Kawai
Yoshinari
Y
Kurihara
Naoko
N
Ookuchi
Souhei
S
Shizuku
Toshihiro
T
Yamamoto
Shyun
S
Hamamoto
Sachiko
S
Kazumori
Hideaki
H
Kinoshita
Yoshikazu
Y
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
D014867:Water