title: Insertion water exchange increases right colon adenoma and hyperplastic polyp detection rates during withdrawal.
abstract: BACKGROUND
  Single site studies in male Veterans in the U.S. reported increased detection of presumptive cancer precursors (adenomas, hyperplastic polyps) in the proximal colon (cecum-splenic flexure) by water exchange.
  
  
  OBJECTIVE
  Assess the reproducibility of the observation.
  
  
  METHODS
  Analysis of secondary outcomes collected prospectively in 3 similarly designed randomized controlled trials using water exchange, water immersion and insufflation (air or carbon dioxide).
  
  
  RESULTS
  detection rates of adenomas and hyperplastic polyps in proximal, transverse and right colon (cecum-ascending).
  
  
  RESULTS
  704 males (173 screening) were evaluated. In the proximal colon, WE showed increased detection of small adenomas (p=0.009) and adenomas plus hyperplastic polyps (p=0.015) (vs insufflation); increased detection of adenomas plus hyperplastic polyps of any size (p=0.045) and of small size (p=0.04) (vs water immersion). In the right colon water exchange increased detection of small adenomas (19% vs 12.1%, p=0.04) (vs insufflation); small adenomas (19% vs 12%, p=0.038), adenomas plus hyperplastic polyps of any size (25% vs 16.7%, p=0.028) and of small size (23.7% vs 14.6%, p=0.012) (vs water immersion). Water exchange significantly improved bowel cleanliness. Sedation had no impact on lesion detection.
  
  
  CONCLUSIONS
  Water exchange is a superior insertion technique for detection of adenomas and hyperplastic polyps primarily in the right colon, especially those of small size.
authors.affiliation: Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy. Electronic address: cadonisergio@gmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Cadoni
authors.affiliation: Digestive Diseases Center, Vìtkovice Hospital, Ostrava, Czech Republic.
authors.forename: Přemysl
authors.initials: P
authors.lastname: Falt
authors.affiliation: Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sanna
authors.affiliation: Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Argiolas
authors.affiliation: Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Fanari
authors.affiliation: Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gallittu
authors.affiliation: Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Liggi
authors.affiliation: Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Mura
authors.affiliation: Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Porcedda
authors.affiliation: Digestive Diseases Center, Vìtkovice Hospital, Ostrava, Czech Republic.
authors.forename: Vit
authors.initials: V
authors.lastname: Smajstrla
authors.affiliation: Department of Surgical Sciences, University of Cagliari, Cagliari, CA, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Erriu
authors.affiliation: Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Felix W
authors.initials: FW
authors.lastname: Leung
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D002432:Cecum / Q000473:pathology; D044682:Colon, Ascending / Q000473:pathology; D003111:Colonic Polyps / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D018153:Czech Republic; D055088:Early Detection of Cancer; D006801:Humans; D006965:Hyperplasia; D007558:Italy; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015203:Reproducibility of Results; D014481:United States; D014867:Water
chemical_list: D014867:Water
keywords: Adenoma detection rate; Colon cleanliness; Interval colon cancer; Right colon hyperplastic polyps