title: Water-Aided Colonoscopy in Inflammatory Bowel Disease Patients-A Randomised, Single-Centre Trial.
abstract: BACKGROUND
  Water-aided colonoscope insertion reduces patients' discomfort and need for sedation in unsedated and minimally sedated patients. However, water-aided technique has never been studied in inflammatory bowel disease patients, characterised by younger age, structural changes of the colon and need for repeated colonoscopies. Our trial was designed to evaluate discomfort associated with water-aided colonoscopy compared with air insufflation in on-demand sedated patients with known inflammatory bowel disease.
  
  
  METHODS
  In a randomised, single-centre study, 92 patients were randomised to either water-aided insertion and air insufflation during withdrawal [Water] or air insufflation during both insertion and withdrawal [Air]. The main outcome measured was success rate of unsedated colonoscopy, defined as reaching the caecum without requiring sedation and with discomfort during insertion of less than or equal to 5 using 0-10 continuous scale [0 = none, 10 = maximum pain].
  
  
  RESULTS
  Success rate of caecal intubation without sedation or invoking a discomfort score greater than 5 was significantly higher in the Water arm compared with the Air arm [73.9 vs 45.7%, p = 0.01]. Discomfort score during insertion [mean ± SD] was significantly lower in the Water than in the Air arm [3.8±2.4 vs 5.4±1.9, p < 0.001]. Other outcomes including procedural times, success rate of terminal ileum intubation, need for abdominal compression, and repositioning were comparable. There were no complications recorded in the study.
  
  
  CONCLUSIONS
  Compared with air insufflation, water-aided colonoscopy significantly reduces discomfort in on-demand sedated patients with inflammatory bowel disease, achieving comparable procedural outcomes.
authors.affiliation: Digestive Diseases Center, Vítkovice Hospital, Ostrava, Czech Republic Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic faltprem@centrum.cz.
authors.forename: Přemysl
authors.initials: P
authors.lastname: Falt
authors.affiliation: Digestive Diseases Center, Vítkovice Hospital, Ostrava, Czech Republic.
authors.forename: Vít
authors.initials: V
authors.lastname: Šmajstrla
authors.affiliation: Digestive Diseases Center, Vítkovice Hospital, Ostrava, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Fojtík
authors.affiliation: Digestive Diseases Center, Vítkovice Hospital, Ostrava, Czech Republic Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Urban
authors.affiliation: Institute of Endocrinology, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Hill
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*; D007327:Insufflation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016037:Single-Blind Method; D014867:Water
chemical_list: D014867:Water
keywords: Water-aided colonoscopy; inflammatory bowel disease