title: Water infusion for cecal intubation increases patient tolerance, but does not improve intubation of unsedated colonoscopies.
abstract: OBJECTIVE
  Several studies have indicated that water infusion, instead of air insufflation, enhances cecal intubation in selected patients undergoing unsedated colonoscopy. We performed a prospective, randomized, controlled trial to investigate whether the water technique increases the proportion of patients that are able to complete unsedated colonoscopy.
  
  
  METHODS
  We analyzed data from 116 consecutive outpatients who were willing to start colonoscopy without sedation; 58 were each randomly assigned to groups given water infusion or air insufflation during the insertion phase. Sedation and analgesia were administered on demand.
  
  
  RESULTS
  Fewer patients requested sedation in the water group (8.6%) than in the air group (34.5%; P = .003) and their maximum pain scores were lower (2.8 ± 1.9 vs 4.2 ± 2.3 in the air group; P = .011). However, differences in percentages of patients who received complete, unsedated colonoscopy between the water group (74.1%) and air group (62.1%) did not reach statistical significance (P = .23); the percentage of successful cecal intubations was lower in the water group (82.8%) than in the air group (96.5%; P = .03) because of poor visibility. Failed procedures in the water group were completed successfully after air insufflation. The cecal intubation time was shorter in the air group (6.2 ± 3.4 min) than in the water group (8.1 ± 3.0 min; P = .01).
  
  
  CONCLUSIONS
  In patients willing to undergo unsedated colonoscopy, water infusion improves patient tolerance for cecal intubation, compared with air insufflation. However, it does not increase the overall percentage of successful cecal intubations because suboptimal bowel preparation interferes with visibility.
authors.affiliation: Department of Internal Medicine II, Dr Horst Schmidt Kliniken, Medical School of the University of Mainz, Wiesbaden, Germany. pohljuergen@web.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pohl
authors.forename: Insa
authors.initials: I
authors.lastname: Messer
authors.forename: Angelika
authors.initials: A
authors.lastname: Behrens
authors.forename: Gernot
authors.initials: G
authors.lastname: Kaiser
authors.forename: Gerhard
authors.initials: G
authors.lastname: Mayer
authors.forename: Christian
authors.initials: C
authors.lastname: Ell
mesh_terms: D000368:Aged; D000388:Air; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007327:Insufflation / Q000379:methods; D007440:Intubation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014867:Water
chemical_list: D006993:Hypnotics and Sedatives; D014867:Water