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Abstract
Background and aims Colonoscopy practice has evolved with a trend towards water-assisted insertion. A recent national survey suggests a hybrid approach to colonic distension during insertion, with water used predominately to the splenic flexure and carbon dioxide (CO2) with water used thereafter to the caecum, is commonly used. This contrasts with the water exchange technique where no CO2 is used. This study aimed to evaluate whether a hybrid or water exchange technique allows more efficient colonoscopy.
Methods This prospective, randomised controlled trial was conducted between March 2021 and June 2022. Participants were randomised 1:1 to hybrid or water exchange colonoscopy, performed by four experienced colonoscopists. The primary outcome was total procedure time with secondary outcomes of caecal intubation time, caecal intubation rate, polyp detection, loop formation, number of ancillary manoeuvres, sedation use and patient comfort.
Results 256 patients were invited, and 246 were randomised to either hybrid or water exchange colonoscopy. 122 patients were included in each arm of the primary analysis. Total procedure time was greater in the water exchange group compared with hybrid (29 vs 25 min, p=0.009). Patient reposition episodes occurred more frequently in the water exchange group vs hybrid group (5.5 vs 5, p=0.003) and left colon Boston Bowel Preparation Scale (BBPS) score was improved. No difference was seen in all other outcomes.
Conclusion A hybrid technique, compared with water exchange, enabled faster colonoscopy without adversely impacting sedation requirement, caecal intubation, overall bowel cleansing and patient comfort. This technique appears to maximise the advantages of both water and CO2 to enable more efficient colonoscopy.
Trial registration number NCT04710706.
- COLONOSCOPY
- ENDOSCOPY
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Statistics from Altmetric.com
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
X @DrAhmirAhmad
Contributors AA and BPS conceived the idea and prepared the protocol. AA wrote the first draft. AA, AB, BM and RM, performed procedures. PB was the study statistician. KT was the dedicated research nurse. All authors had access to the study data, reviewed and approved the final manuscript. AA and BPS were involved in manuscript planning, editing and review and were responsible for overall content as guarantors.
Funding We are grateful for charitable funding administered through St Mark’s Hospital Foundation (funding reference RES256).
Competing interests AA: research funding and equipment loan from Olympus. BPS: received speaker fees, loan equipment and research funding from Olympus and received speaker fees and loan equipment from Fuji. All other authors have no conflicts to declare.
Provenance and peer review Not commissioned; externally peer reviewed.
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