title: A randomized, controlled comparison of warm water infusion in lieu of air insufflation versus air insufflation for aiding colonoscopy insertion in sedated patients undergoing colorectal cancer screening and surveillance.
abstract: BACKGROUND
  Pilot studies using a novel water method to perform screening colonoscopy allowed patients to complete colonoscopy without sedation medications and also significantly increased the cecal intubation success rate.
  
  
  OBJECTIVE
  To perform a randomized, controlled trial comparing air insufflation (conventional method) and water infusion in lieu of air insufflation (study method) colonoscopy in minimally sedated patients.
  
  
  OBJECTIVE
  Compared with the conventional method, patients examined by the study method had lower pain scores and required less medication but had a similar cecal intubation rate and willingness to undergo colonoscopy in the future.
  
  
  METHODS
  Outpatient colonoscopy in a single Veterans Affairs hospital.
  
  
  METHODS
  After informed consent and standard bowel preparation, patients received premedications administered as 0.5-increments of fentanyl (25 microg) and 0.5-increments of Versed (midazolam) (1 mg) plus 50 mg of diphenhydramine. The conventional and the study methods for colonoscopy were implemented as previously described. Additional pain medications were administered at the patients' request.
  
  
  METHODS
  Increments of medications, pain scores, cecal intubation, and willingness to repeat colonoscopy.
  
  
  RESULTS
  Increments of medications used before reaching the cecum (1.6 +/- 0.2 vs 2.4 +/- 0.2, P < .0027), total increments used (1.8 +/- 0.2 vs 2.5 +/- 0.2, P < .014), and the maximum pain scores (1.3 +/- 0.3 vs 4.1 +/- 0.6, P < .0002) were significantly lower with the water method. Cecal intubation rate (100%) and willingness to undergo a repeat colonoscopy (96%) were similar.
  
  
  CONCLUSIONS
  Single Veterans Affairs hospital, older male population.
  
  
  CONCLUSIONS
  Water infusion in lieu of air insufflation is superior to air insufflation during colonoscopy in the minimally sedated patients (ClinicalTrials.gov Identifier NCT00785889).
authors: Section of Gastroenterology, Sacramento Veterans Affairs Medical Center, Veterans Affairs Northern California Health Care System, Mather, California 95655, USA. jwleung@ucdavis.edu
authors: Joseph W
authors: JW
authors: Leung
authors: Surinder K
authors: SK
authors: Mann
authors: Rodelei
authors: R
authors: Siao-Salera
authors: Kanat
authors: K
authors: Ransibrahmanakul
authors: Brian
authors: B
authors: Lim
authors: Hazel
authors: H
authors: Cabrera
authors: Wilhemina
authors: W
authors: Canete
authors: Paul
authors: P
authors: Barredo
authors: Rebeck
authors: R
authors: Gutierrez
authors: Felix W
authors: FW
authors: Leung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D016292:Procedural Sedation / Q000379:methods; D055088:Early Detection of Cancer; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013696:Temperature; D014867:Water / Q000008:administration & dosage*
chemical_list: D014867:Water; D008874:Midazolam; D005283:Fentanyl