title: Warm water infusion versus air insufflation for unsedated colonoscopy: a randomized, controlled trial.
abstract: BACKGROUND
  Uncontrolled data suggest that warm water infusion (WWI) instead of air insufflation (AI) during the insertion phase of unsedated colonoscopy improves patient tolerance and satisfaction.
  
  
  OBJECTIVE
  We tested the hypothesis that water could increase the proportion of patients able to complete unsedated colonoscopy and improve patient tolerance compared with the conventional procedure.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  Single center, community hospital.
  
  
  METHODS
  Consecutive outpatients agreeing to start colonoscopy without premedication.
  
  
  METHODS
  Patients were randomly assigned to either WWI or AI insertion phase of colonoscopy. Sedation and/or analgesia were administered on patient request if significant pain or discomfort occurred.
  
  
  METHODS
  Percentage of patients requiring sedation/analgesia. Pain and tolerance scores were assessed at discharge by using a 100-mm visual analog scale.
  
  
  RESULTS
  A total of 230 subjects (116 in the WWI group and 114 in the AI group) were enrolled. Intention-to-treat analysis showed that the proportion of patients requesting sedation/analgesia during the procedure (main outcome measurement) was 12.9% in the WWI group and 21.9% in AI group (P = .07). Cecal intubation rates were 94% in the WWI group and 95.6% in the AI group (P = .57). Median (interquartile range) scores for pain were 28 (12-44) and 39 (14-54) in WWI and AI groups, respectively (P = .05); corresponding figures for tolerance were 10 (3-18) and 14 (5-42), respectively (P = .01). The adenoma detection rates were 25% and 40.1% for the WWI and AI groups, respectively (P = .013).
  
  
  CONCLUSIONS
  Single-center study, endoscopists not blinded to randomization.
  
  
  CONCLUSIONS
  WWI instead of AI is not associated with a statistically significant decrease in the number of patients requiring on-demand sedation, although it significantly improves the overall patient tolerance of colonoscopy. The finding of a lower adenoma detection rate in the WWI group calls for further evaluations. (
  
  
  BACKGROUND
  NCT00905554).
authors.affiliation: Division of Gastroenterology, Valduce Hospital, Como, Italy. francoradaelli@virgilio.it
authors.forename: Franco
authors.initials: F
authors.lastname: Radaelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Paggi
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Amato
authors.forename: Vittorio
authors.initials: V
authors.lastname: Terruzzi
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D003110:Colonic Neoplasms / Q000175:diagnosis; D003113:Colonoscopy / Q000379:methods*; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D007327:Insufflation; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013696:Temperature; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water