title: Left-colon water exchange preserves the benefits of whole colon water exchange at reduced cecal intubation time conferring significant advantage in diagnostic colonoscopy - a prospective, randomized controlled trial.
abstract: OBJECTIVE
  Whole-colon water exchange (WWE) reduces insertion pain, increases cecal intubation success and adenoma detection rate, but requires longer insertion time, compared to air insufflation (AI) colonoscopy. We hypothesized that water exchange limited to the left colon (LWE) can speed up insertion with equivalent results.
  
  
  METHODS
  This prospective, randomized controlled study (NCT01735266) allocated patients (18-80 years) to WWE, LWE or AI group (1:1:1). The primary outcome was cecal intubation time.
  
  
  RESULTS
  Three hundred subjects were randomized to the WWE (n = 100), LWE (n = 100) or AI group (n = 100). Ninety-four to ninety-five per cent of patients underwent diagnostic colonoscopy. Baseline characteristics were balanced. The median insertion time was shorter in LWE group (4.8 min (95%CI: 3.2-6.2)) than those in WWE (7.5 min (95%CI: 6.0-10.3)) and AI (6.4 min (95%CI: 4.2-9.8)) (both p < 0.001) groups. The cecal intubation rates in unsedated patients of the two water exchange methods (WWE 99%, LWE 99%) were significantly higher than that (89.8%) in AI group (p = 0.01). The final success rates were comparable among the three groups after sedation was given. Maximum pain scores and number of patients needing abdominal compression between WWE and LWE groups were comparable, both lower than those in AI group (p < 0.05). No significant difference was observed regarding PDR, although the PDR in right colon tended to be higher in WWE group.
  
  
  CONCLUSIONS
  By preserving the benefits of WWE and reducing insertion time, LWE is appropriate for diagnostic colonoscopy, especially in settings with tight scheduling of patients. The higher PDR in the right colon in WWE group deserves to be further investigated.
authors: Xijing Hospital of Digestive Diseases, Fourth Military Medical University , Xi'an , China.
authors: Xiangping
authors: X
authors: Wang
authors: Hui
authors: H
authors: Luo
authors: Yi
authors: Y
authors: Xiang
authors: Felix W
authors: FW
authors: Leung
authors: Limei
authors: L
authors: Wang
authors: Linhui
authors: L
authors: Zhang
authors: Zhiguo
authors: Z
authors: Liu
authors: Kaichun
authors: K
authors: Wu
authors: Daiming
authors: D
authors: Fan
authors: Yanglin
authors: Y
authors: Pan
authors: Xuegang
authors: X
authors: Guo
mesh_terms: D015746:Abdominal Pain; D000328:Adult; D002681:China; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D007440:Intubation; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D063868:Patient Outcome Assessment; D011187:Posture; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014867:Water
chemical_list: D014867:Water
keywords: cecal intubation time; left colon; water exchange colonoscopy