title: Impact of Colonoscopy Insertion Techniques on Adenoma Detection.
abstract: Low adenoma detection rate (ADR) predicts development of interval cancers, found mainly in the right (cecum-ascending) colon, where poor bowel preparation is an associated factor. Single-site studies reported increased detection of adenomas in the proximal colon segments by water exchange (WE). Data about colon cleansing revealed that WE had the greatest impact in the right colon.
  
  
  
  To test the hypothesis that WE had the greatest impact on ADR in colon segments with the most favorable bowel cleanliness scores, namely the right colon.
  
  
  
  We pooled right colon and overall ADR data of three similarly designed colonoscopy trials that compared WE, water immersion (WI) and insufflation of air or carbon dioxide (AICD) in a mixed gender European population.
  
  
  
  In this study, 1200 (704 males) subjects and were included. 288 were screening cases. Demographic and procedural data were comparable. Water exchange achieved significantly higher right colon <10 mm ADR (11.9 %, vs WI 6.9 %, p = 0.016; vs AICD 7.2 %, p = 0.025). Water exchange achieved the lowest proportions of poor bowel preparation and the highest right colon and overall Boston bowel preparation scale scores (p range 0.003, <0.0005). In patients with right colon excellent bowel cleanliness, water exchange was the only method significantly associated with right colon adenoma detection. One of the limitations is unblinded colonoscopists.
  
  
  
  In a mixed gender European population, water exchange is confirmed to be a superior insertion technique showing a significant increase in <10 mm right colon adenoma detection, achieving the cleanest colon and lowest proportions of poor bowel preparation requiring repeat procedures. CLINICALTRIALS.
  
  
  
  NCT01781650, 01954862, 01780818.
authors: Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy. cadonisergio@gmail.com.
authors: Sergio
authors: S
authors: Cadoni
authors: Digestive Diseases Center, Vìtkovice Hospital, Zálužanského 1192/15, 703 84, Ostrava, Czech Republic.
authors: Přemysl
authors: P
authors: Falt
authors: Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy.
authors: Stefano
authors: S
authors: Sanna
authors: Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy.
authors: Mariangela
authors: M
authors: Argiolas
authors: Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy.
authors: Viviana
authors: V
authors: Fanari
authors: Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy.
authors: Paolo
authors: P
authors: Gallittu
authors: Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy.
authors: Mauro
authors: M
authors: Liggi
authors: Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy.
authors: Donatella
authors: D
authors: Mura
authors: Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy.
authors: Maria L
authors: ML
authors: Porcedda
authors: Digestive Diseases Center, Vìtkovice Hospital, Zálužanského 1192/15, 703 84, Ostrava, Czech Republic.
authors: Vit
authors: V
authors: Smajstrla
authors: Department of Surgical Sciences, University of Cagliari, 09121, Cagliari, Italy.
authors: Matteo
authors: M
authors: Erriu
authors: Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, 91343, USA.|David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, 90024, USA.
authors: Felix W
authors: FW
authors: Leung
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D044682:Colon, Ascending / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Bowel cleanliness; Colon lesion detection; Interval cancer; Small adenomas; Water-aided colonoscopy