Water-aided colonoscopy: a systematic review.
BACKGROUND
Water-aided methods for colonoscopy are distinguished by the timing of removal of infused water, predominantly during withdrawal (water immersion) or during insertion (water exchange).


OBJECTIVE
To discuss the impact of these approaches on colonoscopy pain and adenoma detection rate (ADR).


METHODS
Systematic review.


METHODS
Randomized, controlled trial (RCT) that compared water-aided methods and air insufflation during colonoscope insertion.


METHODS
Patients undergoing colonoscopy.


METHODS
Medline, PubMed, and Google searches (January 2008-December 2011) and personal communications of manuscripts in press were considered to identify appropriate RCTs.


METHODS
Pain during colonoscopy and ADR. RCTs were grouped according to whether water immersion or water exchange was used. Reported pain scores and ADR were tabulated based on group assignment.


RESULTS
Pain during colonoscopy is significantly reduced by both water immersion and water exchange compared with traditional air insufflation. The reduction in pain scores was qualitatively greater with water exchange as compared with water immersion. A mixed pattern of increases and decreases in ADR was observed with water immersion. A higher ADR, especially proximal to the splenic flexure, was obtained when water exchange was implemented.


CONCLUSIONS
Differences in the reports limit application of meta-analysis. The inability to blind the colonoscopists exposed the observations to uncertain bias.


CONCLUSIONS
Compared with air insufflation, both water immersion and water exchange significantly reduce colonoscopy pain. Water exchange may be superior to water immersion in minimizing colonoscopy discomfort and in increasing ADR. A head-to-head comparison of these 3 approaches is required.
Research and Medical Services, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, Los Angeles, California 91343, USA.
Felix W
FW
Leung
Arnaldo
A
Amato
Christian
C
Ell
Shai
S
Friedland
Judith O
JO
Harker
Yu-Hsi
YH
Hsieh
Joseph W
JW
Leung
Surinder K
SK
Mann
Silvia
S
Paggi
Jürgen
J
Pohl
Franco
F
Radaelli
Francisco C
FC
Ramirez
Rodelei
R
Siao-Salera
Vittorio
V
Terruzzi
D000236:Adenoma / Q000175:diagnosis*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D006801:Humans; D007327:Insufflation / Q000009:adverse effects; D010146:Pain / Q000209:etiology; D014867:Water / Q000008:administration & dosage* / Q000009:adverse effects
D014867:Water