title: A pilot study to assess feasibility of the water method to aid colonoscope insertion in community settings in the United States.
abstract: BACKGROUND: The water method decreases patient discomfort and sedation requirement. Applicability in non-veteran community settings in the United States (U.S.) has not been reported.  AIMS: Our aim is to perform a pilot study to establish feasibility of use the water method at 2 community sites. We tested the hypothesis that compared with air insufflation patients examined with the water method would require less sedation without adverse impact on outcomes.  METHODS: Two performance improvement projects were carried out. Consecutive patients who consented to respond to a questionnaire after colonoscopy were enrolled. Project 1: The design was single-blinded (patient only); quasi-randomized - odd days (water), even days (air). Colonoscopy was performed by a staff attending. Project 2: A supervised trainee performed the reported procedures. In both, patient demographics (age, gender and body mass index), amount of sedation required during colonoscopy and procedure-related variables were recorded. The patients completed a questionnaire that enquired about discomfort during colonoscopy and willingness to repeat the procedure within 24 hours after the procedure.  RESULTS: Project 1: Significantly lower doses of fentanyl and midazolam were used and a higher adenoma detection rate (ADR) was demonstrated in the water group. Project 2: 100% cecal intubation rate was achieved by the supervised trainee.  CONCLUSION: This is the first pilot report in the U.S. documenting feasibility of the water method as the principal modality to aid colonoscope insertion in both male and female community patients. In a head-to-head comparison, significant reduction of sedation requirement is confirmed as hypothesized. No adverse impact on outcomes was noted.
authors.affiliation: Gastroenterology, Loma Linda University Medical Center, Loma Linda, CA, United States.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Portocarrero
authors.forename: Kendrick
authors.initials: K
authors.lastname: Che
authors.forename: Snorri
authors.initials: S
authors.lastname: Olafsson
authors.forename: Michael H
authors.initials: MH
authors.lastname: Walter
authors.forename: Christian S
authors.initials: CS
authors.lastname: Jackson
authors.forename: Felix W
authors.initials: FW
authors.lastname: Leung
authors.forename: Ariel
authors.initials: A
authors.lastname: Malamud