title: Water-related techniques for performance of colonoscopy.
abstract: BACKGROUND
  Passage through difficult colonic segments, cecal intubation rate, time to reach the cecum, procedure-related discomfort, and medication requirement are important outcome measures of a colonoscopic examination. Several techniques of water infusion to aid insertion have been described. Raising awareness of these simple inexpensive methods may help to enhance colonoscopists' performance.
  
  
  OBJECTIVE
  To review water-related methods that facilitated colonoscope insertion.
  
  
  METHODS
  A literature search (Medline, PubMed) was conducted using the following terms: sigmoidoscopy, colonoscopy, and water infusion, irrigation, or loading. The effects of water infusion in sedated and unsedated patients are tabulated and discussed.
  
  
  RESULTS
  Five reports described the use of water infusion in conjunction with usual air insufflation. Enhanced cecal intubation, decreased time to reach the cecum, and attenuated abdominal discomfort were reported. Dose of medication used for sedation was not reduced. The sixth report described a novel method of water infusion in lieu of air insufflation during insertion. When patients accepted sedation on demand, the novel method permitted 52% to complete colonoscopy without sedation.
  
  
  CONCLUSIONS
  Warm water infusion as an adjunct to usual air insufflation enhances colonoscopy outcome. Randomized controlled trials comparing the novel method with usual air insufflation deserve to be considered.
authors.affiliation: The Research and Medical Services, VA Greater Los Angels Healthcare System, North Hills, CA 91343, USA. felix.leung@va.gov
authors.forename: Felix W
authors.initials: FW
authors.lastname: Leung
mesh_terms: D003113:Colonoscopy / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D007507:Therapeutic Irrigation / Q000379:methods*; D014867:Water
chemical_list: D014867:Water