The water method combined with chromoendoscopy enhances adenoma detection.

BACKGROUND: The water method is easy-to-learn and improves colonoscopy outcomes. Dye-spray chromoendoscopy enhances ADR but has not been widely accepted for routine application in screening or surveillance colonoscopy. HYPOTHESIS: With dye added to the water used in the water method, ADR can be enhanced compared with the water or air method alone. OBJECTIVE: To compare ADR determined by the air method, water method alone, and water method with indigo carmine (0.008%) added. DESIGN: Review of prospectively collected data in a performance improvement program. SETTING: VA endoscopy unit. PATIENT: Screening or surveillance colonoscopy. METHODS: Patients (n=50/group) underwent colonoscopy with each of the three methods. Water method involved warm water infusion in lieu of air insufflation coupled with removal of residual air by suction and residual feces by water exchange. ADR and procedural data were collected prospectively to monitor performance. MAIN OUTCOME MEASUREMENTS: ADR. RESULTS: ADR in the air method, water method alone and water method with indigo carmine were 36%, 40% and 62%, respectively. Water method with indigo carmine produced significantly higher ADR than the air or water method alone (p<0.05). LIMITATIONS: Non-randomized data, single VA site, retrospective comparison. Absence of significant difference between air and water methods could be a type II error due to small number of patients CONCLUSIONS: The approach with indigo carmine added to the water used in the water method yielded significantly higher ADR than the water or the air method alone. The data suggest that a prospective RCT to compare the different methods is warranted.

Pilot feasibility study of the method of water infusion without air insufflation in sedated colonoscopy.

One study in sedated patients demonstrated a reduction in pain score but not midazolam dosage when warm water infusion was used to manage colonic spasm. We describe pilot data with a modified warm water infusion technique. We tested the hypothesis that patients receiving even only half of the usual dose of sedation medications would have acceptable cecal intubation and tolerate the procedure well, based on retrospective review of prospectively collected data from a single Veterans Affairs (VA) medical center. Group 1 included 32 consecutive patients who received full-dose and group 2 included 43 consecutive patients who received half-dose premedication. Insertion of colonoscope was aided by warm water infusion in lieu of air insufflation. Pain scores during insertion, cecal intubation rate, and total amount of medications were monitored. The novel technique permitted equal cecal intubation rate at reduced total dose of medications. Pain scores were not significantly different. The uncontrolled nonrandomized observational nature of the data is one limitation. The nonsignificant difference in pain scores may be affected by a type II error. These pilot data suggest that insertion is feasible without air when water infusion is used. The novel technique may be a useful adjunct for minimizing the dosage of sedation medications without adversely affecting cecal intubation. Further study is needed to compare air insufflation and water infusion with regard to patient tolerance and success, particularly in the presence of an on-demand sedation policy.

Options for screening colonoscopy without sedation: sequel to a pilot study in U.S. veterans.

BACKGROUND: Sedation on demand combined with a novel water infusion technique enabled 23 of 44 veterans to complete screening colonoscopy without sedation. OBJECTIVE: With use of the usual air insufflation technique, we determined the proportion of patients who could complete colonoscopy without sedation. DESIGN: Retrospective review of prospectively collected data in a performance improvement project to minimize the burden of sedation. SETTING: A Veterans Affairs open access screening colonoscopy program. SUBJECTS: Ninety-three consecutive veterans who accepted on-demand sedation or scheduled no sedation. METHOD: Usual air insufflation during colonoscope insertion. Medications were administered at the veteran's request. RESULTS: Twenty-three veterans chose scheduled unsedated colonoscopy; 22 were completed without sedation. Sedation on demand enabled 54 to complete the procedure without medications; 16 requested medications to complete colonoscopy. Nurses' expectations indicated that the choices were credible options. CONCLUSIONS: Options for screening colonoscopy without sedation combined with usual air insufflation are feasible among U.S. veterans. Confirmation by randomized controlled trial and evaluation of the impact on institutional costs and patient adherence to screening and surveillance colonoscopy deserve to be considered.