title: The water method is effective in difficult colonoscopy - it enhances cecal intubation in unsedated patients with a history of abdominal surgery.
abstract: BACKGROUND: Colonoscopy in unsedated patients in the US is considered to be difficult. Success rate of cecal intubation is limited by discomfort. Colonoscopy in patients with a history of abdominal surgery is also considered to be difficult due to adhesion-related bowel angulations. The water method has been shown to significantly reduce pain during colonoscopy.  OBJECTIVE: To test the hypothesis that the water method enhances the completion of colonoscopy in unsedated patients with a history of abdominal surgery.  DESIGN: The data bases of two parallel RCT were combined and analyzed.  SETTING: Two Veterans Affairs endoscopy units.  PATIENT AND METHODS: The water and air methods were compared in these two parallel RCT examining unsedated patients. Those with a history of abdominal surgery were selected for evaluation.  MAIN OUTCOME MEASUREMENTS: Completion of unsedated colonoscopy.  RESULTS: Among patients with a history of abdominal surgery, the proportion completing unsedated colonoscopy in the water group (19 of 22) was significantly higher than that (11 of 22) in the air group (p=0.0217, Fisher's exact test).  LIMITATIONS: Small number of predominantly male veterans, unblinded colonoscopists, not all types of abdominal surgery (e.g. hysterectomy, gastrectomy) predisposing to difficult colonoscopy were represented.  CONCLUSION: This proof-of-principle assessment confirms that in patients with a history of abdominal surgery the water method significantly increases the proportion able to complete unsedated colonoscopy. The water method deserves to be evaluated in patients with other factors associated with difficult colonoscopy.
authors.affiliation: Gastroenterology, Sepulveda ACC, VAGLAHS, North Hill.
authors.forename: Felix W
authors.initials: FW
authors.lastname: Leung
authors.forename: Surinder K
authors.initials: SK
authors.lastname: Mann
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Leung
authors.forename: Rodelei M
authors.initials: RM
authors.lastname: Siao-Salera
authors.forename: Jackson
authors.initials: J
authors.lastname: Guy