title: A randomized, controlled trial to confirm the beneficial effects of the water method on U.S. veterans undergoing colonoscopy with the option of on-demand sedation.
abstract: BACKGROUND
  Sedation for colonoscopy discomfort imposes a recovery-time burden on patients. The water method permitted 52% of patients accepting on-demand sedation to complete colonoscopy without sedation. On-site and at-home recovery times were not reported.
  
  
  OBJECTIVE
  To confirm the beneficial effect of the water method and document the patient recovery-time burden.
  
  
  METHODS
  Randomized, controlled trial, with single-blinded, intent-to-treat analysis.
  
  
  METHODS
  Veterans Affairs outpatient endoscopy unit.
  
  
  METHODS
  This study involved veterans accepting on-demand sedation for screening and surveillance colonoscopy.
  
  
  METHODS
  Air versus water method for colonoscope insertion.
  
  
  METHODS
  Proportion of patients completing colonoscopy without sedation, cecal intubation rate, medication requirement, maximum discomfort (0 = none, 10 = severe), procedure-related and patient-related outcomes.
  
  
  RESULTS
  One hundred veterans were randomized to the air (n = 50) or water (n = 50) method. The proportions of patients who could complete colonoscopy without sedation in the water group (78%) and the air group (54%) were significantly different (P = .011, Fisher exact test), but the cecal intubation rate was similar (100% in both groups). Secondary analysis (data as Mean [SD]) shows that the water method produced a reduction in medication requirement: fentanyl, 12.5 (26.8) μg versus 24.0 (30.7) μg; midazolam, 0.5 (1.1) mg versus 0.94 (1.20) mg; maximum discomfort, 2.3 (1.7) versus 4.9 (2.0); recovery time on site, 8.4 (6.8) versus 12.3 (9.4) minutes; and recovery time at home, 4.5 (9.2) versus 10.9 (14.0) hours (P = .049; P = .06; P = .0012; P = .0199; and P = .0048, respectively, t test).
  
  
  CONCLUSIONS
  Single Veterans Affairs site, predominantly male population, unblinded examiners.
  
  
  CONCLUSIONS
  This randomized, controlled trial confirms the reported beneficial effects of the water method. The combination of the water method with on-demand sedation minimizes the patient recovery-time burden. (
  
  
  BACKGROUND
  NCT00920751.).
authors.affiliation: Gastroenterology, University of California Davis Medical Center, Sacramento, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Leung
authors.forename: Surinder
authors.initials: S
authors.lastname: Mann
authors.forename: Rodelei
authors.initials: R
authors.lastname: Siao-Salera
authors.forename: Kanat
authors.initials: K
authors.lastname: Ransibrahmanakul
authors.forename: Brian
authors.initials: B
authors.lastname: Lim
authors.forename: Wilhelmina
authors.initials: W
authors.lastname: Canete
authors.forename: Laramie
authors.initials: L
authors.lastname: Samson
authors.forename: Rebeck
authors.initials: R
authors.lastname: Gutierrez
authors.forename: Felix W
authors.initials: FW
authors.lastname: Leung
mesh_terms: D000368:Aged; D000388:Air; D000701:Analgesics, Opioid / Q000008:administration & dosage; D003113:Colonoscopy / Q000379:methods*; D016292:Procedural Sedation; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D057194:Intention to Treat Analysis; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D017060:Patient Satisfaction; D016037:Single-Blind Method; D014481:United States; D014728:Veterans; D014867:Water / Q000008:administration & dosage*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D014867:Water; D008874:Midazolam; D005283:Fentanyl