Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations.

Published on Oct 16, 2020in Gastrointestinal Endoscopy6.89
· DOI :10.1016/J.GIE.2020.10.011
Sergio Cadoni13
Estimated H-index: 13
(CTO Hospital),
Sauid Ishaq12
Estimated H-index: 12
(BCU: Birmingham City University)
+ 52 AuthorsFelix W. Leung51
Estimated H-index: 51
(UCLA: University of California, Los Angeles)
Sources
Abstract
Background and Aims Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. Methods Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. Results In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). Conclusions The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.
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Last. Felix W. Leung (UCLA: University of California, Los Angeles)H-Index: 51
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Goals To test the hypothesis that water exchange (WE), when compared with carbon dioxide (CO2) insufflation, significantly reduces the right colon adenoma miss rate (rAMR) in a blinded randomized controlled trial with cap-assisted colonoscopy. Background The unblinded consecutive group observational data showed that WE significantly decreased rAMR. The unblinded data are limited by potential bias. Study Consecutive patients aged 45 years or more were randomized to undergo insertion with WE or CO...
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Background & Aims Endoscopic mucosal resection (EMR) with submucosal injection is an established method for removing colorectal polyps, although the en bloc resection rate decreases when polyp size exceeds 10 mm. Piecemeal resection increases local recurrence. Underwater EMR (UEMR) is an effective technique for removal of sessile colorectal polyps and we investigated whether it is superior to conventional EMR (CEMR). Methods We conducted a multicenter randomized controlled trial at 5 institution...
35 CitationsSource
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BackgroundExperts have hypothesized that a reduction of multitasking distractions and improved bowel cleanliness can explain why insertion water exchange enhances adenoma detection rate.ObjectiveTh...
11 CitationsSource
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Background and Aims Although water exchange may improve adenoma detection compared with CO 2 , it is unclear whether water is a better medium to fill the lumen during withdrawal and visualize the mucosa. Total underwater colonoscopy (TUC) involves the use of water exchange with the air valve off during insertion followed by the inspection of the mucosa under water. Our goal was to compare miss rates for TUC with standard CO 2 for polyps and adenomas using a tandem colonoscopy design. Methods We ...
14 CitationsSource
#1Felix W. Leung (UCLA: University of California, Los Angeles)H-Index: 51
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4 CitationsSource
#1Sergio Cadoni (CTO Hospital)H-Index: 13
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Last. Felix W. Leung (UCLA: University of California, Los Angeles)H-Index: 51
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Background and Aims Separate randomized controlled trials (RCTs) showed water exchange (WE) colonoscopy outperformed other techniques in minimizing insertion pain and optimizing adenoma detection rate. Longer insertion time required for removal of infused water, residual air, and feces might have hampered its wider adoption. We evaluate the impact of WE compared with air or carbon dioxide insufflation (GAS) on room turnaround efficiency measured by cecal intubation, withdrawal, and total procedu...
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Background and Aims Water-aided colonoscopy techniques, such as water immersion (WI) and water exchange (WE), have shown different results regarding adenoma detection rate (ADR). We determined the impact of WI and WE on ADR and other procedural outcomes versus gas (air, AI; CO2) insufflation colonoscopy. Methods A systematic search of multiple databases for randomized controlled trials comparing WI and/or WE with AI and/or CO2 and reporting ADR was conducted. A network meta-analysis with mixed c...
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Background/Aims: Recently, water exchange (WE) instead of water immersion (WI) for colonoscopy has been proposed to decrease pain and improve adenoma detection rate (ADR). This systematic review and meta-analysis is conducted to assess whether WE is superior to WI based on the published randomized controlled trials (RCTs). Materials and Methods: We searched studies from PubMed, Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE. Only RCTs were eligible for our study. The pooled ...
7 CitationsSource
Cited By1
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Randomized control trials and meta-analyses comparing colonoscopies with and without computer-aided detection (CADe) assistance showed significant increases in adenoma detection rates (ADRs) with CADe. A major limitation of CADe is its false positives (FPs), ranked 3rd in importance among 59 research questions in a modified Delphi consensus review. The definition of FPs varies. One commonly used definition defines an FP as an activation of the CADe system, irrespective of the number of frames or...
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#2Keith SiauH-Index: 14
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Rutter et al 1 should be congratulated on this first randomised controlled trial (RCT) comparing water-assisted sigmoidoscopy (WAS) versus carbon dioxide (CO2) insufflation in patients undergoing English Bowel Scope Screening (BSS). The authors reported no significant difference in the primary outcome of recalled pain, or in secondary outcomes of adenoma detection rate (ADR) between WAS and CO2 insufflation groups. Before we consider the study findings, we would like to discuss the following poi...
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