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Water Exchange Produces Significantly Higher Adenoma Detection Rate Than Water Immersion

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Goals:

To test the hypothesis that water exchange (WE) significantly increases adenoma detection rates (ADR) compared with water immersion (WI).

Background:

Low ADR was linked to increased risk for interval colorectal cancers and related deaths. Two recent randomized controlled trials of head-to-head comparison of WE, WI, and traditional air insufflation (AI) each showed that WE achieved significantly higher ADR than AI, but not WI. The data were pooled from these 2 studies to test the above hypothesis.

Study:

Two trials (5 sites, 14 colonoscopists) that randomized 1875 patients 1:1:1 to AI, WI, or WE were pooled and analyzed with ADR as the primary outcome.

Results:

The ADR of AI (39.5%) and WI (42.4%) were comparable, significantly lower than that of WE (49.6%) (vs. AI P=0.001; vs. WI P=0.033). WE insertion time was 3 minutes longer than that of AI (P<0.001). WE showed significantly higher detection rate (vs. AI) of the >10 mm advanced adenomas. Right colon combined advanced and sessile serrated ADR of AI (3.4%) and WI (5%) were comparable and were significantly lower than that of WE (8.5%) (vs. AI P<0.001; vs. WI P=0.039).

Conclusions:

Compared with AI and WI, the superior ADR of WE offsets the drawback of a significantly longer insertion time. For quality improvement focused on increasing adenoma detection, WE is preferred over WI. The hypothesis that WE could lower the risk of interval colorectal cancers and related deaths should be tested.
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Keywords: adenoma detection rate (ADR); air insufflation (AI); water exchange (WE); water immersion (WI)

Document Type: Research Article

Affiliations: 1: Department of Gastroenterology/Medicine, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, Department of Gastroenterology/Medicine, David Geffen School of Medicine at UCLA, Los Angeles 2: Departments of Medical Research, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada 3: Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias (CI) 4: Digestive Diseases Center, Vitkovice Hospital, Ostrava, Czech Republic 5: Gastroenterology/Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Gastroenterology/Medicine, Tzu Chi University School of Medicine 6: Department of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como 7: Department of Surgical Sciences, University of Cagliari (CA), Cagliari (CA), Italy 8: Gastroenterology/Medicine, Tzu Chi University School of Medicine, Department of Gastroenterology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan 9: Department of Gastroenterolgy, UC Davis Medical Center, Sacramento, Department of Gastroenterology, Sacramento VAMC, Veterans Affairs Northern California Healthcare System, Mather, CA

Publication date: March 1, 2019

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