title: A novel method with significant impact on adenoma detection: combined water-exchange and cap-assisted colonoscopy.
abstract: BACKGROUND
  Water exchange provides salvage cleansing and improves adenoma detection, but drawbacks include prolonged procedure time. Cap-assisted colonoscopy decreases cecal intubation time but is limited by impaired views when feces lodge in the cap.
  
  
  OBJECTIVE
  To investigate the impact of combined water-exchange and cap-assisted colonoscopy (WCC) on detection of adenomas and proximal colon serrated polyps.
  
  
  METHODS
  Retrospective, single-center, single-colonoscopist, consecutive group observational study.
  
  
  METHODS
  Veterans Affairs outpatient endoscopy suite.
  
  
  METHODS
  Outpatients undergoing screening or surveillance colonoscopy.
  
  
  METHODS
  WCC data collected from 100 consecutive patients were compared to a control group of 101 consecutive patients examined with conventional air insufflation colonoscopy during the prior 4-month period.
  
  
  METHODS
  Adenoma detection rate (ADR), adenomas detected per colonoscopy, proximal colon serrated polyp detection rate, and proximal colon serrated polyps per colonoscopy rate.
  
  
  RESULTS
  Compared with controls, the WCC group had a higher polyp detection rate (93.0% vs 84.2%; P = .07), ADR (75.0% vs 59.4%; P = .02), proximal colon ADR (61.0% vs 47.5%; P = .07), proximal colon serrated polyp detection rate (24.0% vs 9.9%; P = .009), number of adenomas per colonoscopy (2.70 vs 1.50; P = .002), and mean number of proximal colon serrated polyps per colonoscopy (0.38 vs 0.12; P = .004).
  
  
  CONCLUSIONS
  Retrospective study; single, unblinded endoscopist.
  
  
  CONCLUSIONS
  ADR and adenomas per colonoscopy are both sensitive indicators of colonoscopy quality. WCC merges two simple methods to improve the performance of screening and surveillance colonoscopy. The data suggest that larger, prospective studies are necessary to determine if there are differences between water-exchange combined with cap-assisted maneuvers and the individual components used alone in lesion detection in screening and surveillance colonoscopy.
authors.affiliation: Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, Mather, California 95655, USA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Yen
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Leung
authors.forename: Felix W
authors.initials: FW
authors.lastname: Leung
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D014867:Water
chemical_list: D014867:Water