Abstract
Background and Study Aims
There is general consensus that water instillation helps insert a colonoscope. However, the most effective method for water instillation has not yet been established, especially for endoscopists-in-training. The aim of this study was to determine volume and temperature for effective water instillation colonoscopy.
Patients and Methods
This is a prospective, randomized, controlled trial that was carried out at a single center, and a total of 207 consecutive subjects who underwent colonoscopic examination for health checkup were included in the study. Water instillation of supplied water was conducted under four different conditions: 100 and 300 ml at room temperature, 300 ml at 30°C and no use of water instillation. The following parameters were recorded and analyzed: intubation success rate, independent predictors of successful intubation and intubation time to reach the cecum.
Results
The intubation success rate was not significantly different between individual groups. Independent predictors of successful intubation were younger age (P = 0.004) and later examined subjects (P = 0.016). The 300-ml warm water instillation during colonoscopy significantly reduced intubation time over the conventional method without water instillation (P = 0.034).
Conclusions
Instillation of 300-ml warm (30°C) water during colonoscopy can reduce cecal intubation time for in-training endoscopists without improving the intubation success rate.
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References
Lindsay DC, Freeman JG, Cobden I, Record CO. Should colonoscopy be the first investigation for colonic disease? Br Med J (Clin Res Ed). 1988;296:167–169.
Baumann UA. Water intubation of the sigmoid colon: water instillation speeds up left-sided colonoscopy. Endoscopy. 1999;31:314–317.
Brocchi E, Pezzilli R, Bonora M, Tomassetti P, Romanelli M, Corinaldesi R. Oil-lubricated colonoscopy: easier and less painful? Endoscopy. 2005;37:340–345.
Brocchi E, Pezzilli R, Tomassetti P, Campana D, Morselli-Labate AM, Corinaldesi R. Warm water or oil-assisted colonoscopy: toward simpler examinations? Am J Gastroenterol. 2008;103:581–587.
Church JM. Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective. Gastrointest Endosc. 2002;56:672–674.
Hamamoto N, Nakanishi Y, Morimoto N, et al. A new water instillation method for colonoscopy without sedation as performed by endoscopists-in-training. Gastrointest Endosc. 2002;56:825–828.
Leung JW, Mann S, Leung FW. Options for screening colonoscopy without sedation: a pilot study in United States veterans. Aliment Pharmacol Ther. 2007;26:627–631.
Park SC, Keum B, Kim ES, et al. Usefulness of warm water and oil assistance in colonoscopy by trainees. Dig Dis Sci. 2010;22:2940–2944.
Lichtenstein DR, Jagannath S, Baron TH, et al. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2008;68:815–826.
Gupta T, Mandot A, Desai D, Abraham P, Joshi A, Shah S. Comparison of two schedules (previous evening vs. same morning) of bowel preparation for colonoscopy. Endoscopy. 2007;39:706–709.
Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: L. Erlbaum Associates; 1988.
Falchuk ZM, Griffin PH. A technique to facilitate colonoscopy in areas of severe diverticular disease. N Engl J Med. 1984;310:598.
Leung JW, Mann SK, Siao-Salera R, et al. A randomized, controlled comparison of warm water infusion in lieu of air insufflation versus air insufflation for aiding colonoscopy insertion in sedated patients undergoing colorectal cancer screening and surveillance. Gastrointest Endosc. 2009;70:505–510.
Leung J, Mann S, Siao-Salera R. A randomized controlled trial to confirm the beneficial effects of the water method on US veterans undergoing colonoscopy with the option of on-demand sedation. Gastrointest Endosc. 2011;73:103–110.
Leung FW, Harker JO, Jackson G, et al. A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method. Gastrointest Endosc. 2010;72:693–700.
Leung CW, Kaltenbach T, Soetikno R, Wu KK, Leung FW, Friedland S. Water immersion versus standard colonoscopy insertion technique: randomized trial shows promise for minimal sedation. Endoscopy. 2010;42:557–563.
Ransibrahmanakul K, Leung JW, Mann FSK, et al. Comparative effectiveness of water versus air methods in minimal sedation colonoscopy performed by supervised trainees in the US-randomized controlled trial. Am J Clin Med. 2010;7:113–118.
Chung JI, Kim N, Um MS, et al. Learning curves for colonoscopy: a prospective evaluation of gastroenterology fellows at a single center. Gut Liver. 2010;4:31–35.
American Society for Gastrointestinal Endoscopy. Guidelines for credentialing and granting privileges for gastrointestinal endoscopy. Gastrointest Endosc. 1998;48:679–682.
Cass OW, Freeman ML, Peine CJ, Zera RT, Onstad GR. Objective evaluation of endoscopy skills during training. Ann Intern Med. 1993;118:40–44.
Lee SH, Chung IK, Kim SJ, et al. An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve. Gastrointest Endosc. 2008;67:683–689.
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Ryu, KH., Huh, KC., Kang, YW. et al. An Effective Instillation Method for Water-Assisted Colonoscopy as Performed by In-Training Endoscopists in Terms of Volume and Temperature. Dig Dis Sci 57, 142–147 (2012). https://doi.org/10.1007/s10620-011-1842-4
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DOI: https://doi.org/10.1007/s10620-011-1842-4