Water immersion simplifies cecal intubation in patients with redundant colons and previous incomplete colonoscopies

Background: Interest in effective ways to complete colon examinations in patients who had previously undergone failed colonoscopies has increased recently.

Objective: To determine whether water immersion decreased the need for ancillary equipment to achieve cecal intubation in patients who had previously undergone incomplete colonoscopies.

Design: Retrospective cohort study.

Setting: Tertiary academic center.

Patients: A total of 345 consecutive patients referred to a tertiary center for the indication of a previous incomplete colonoscopy.

Interventions: Colonoscopy with or without water immersion insertion.

Main outcome measurements: Cecal intubation rates, type of equipment, and maneuvers used.

Results: Cecal intubation was achieved in 332 of 345 patients (96.2%) and was similar in those with and without water immersion (170/178, 95.5% vs 162/167, 97%, P = .58). An external straightening device was used in 6 of 178 cases with water immersion (3.4%) compared with 25 of 168 cases with air insufflation (15%) (P < .0001). Among patients with a redundant colon as the sole cause of previously incomplete examinations, water immersion required an external straightener in 7% compared with 37% with air insufflation during insertion (P < .0001), and position change was required in 5% of those with water immersion compared with 22% with air insufflation (P = .01).

Limitations: Retrospective review; single-center, single-endoscopist study.

Conclusion: Water immersion decreases the need for external straightening devices and position change maneuvers in patients with redundant colons and previously incomplete colonoscopies.