Experience with water-aided colonoscopy in a Canadian community population.

PURPOSE: Water-aided colonoscopy, immersion (WI) or exchange (WE), minimizes insertion pain and reduces sedation. WE improves adenoma detection rates (ADR). In a performance improvement program, we assessed water-aided methods in a busy community GI practice in Canada.

METHODS: Over a 13 month period patients were offered water-aided colonoscopy with an option to complete the examination with on-demand sedation. WI was used in the first 1-2 months and replaced exclusively with WE thereafter. Procedural outcomes were compared to a continuous retrospective cohort of standard sedated air insufflation (AI) colonoscopy.

RESULTS: 200 (106M/94F) water-aided colonoscopies were completed. Cecal intubation without air insufflation was achieved in 93%. Sedation was not required in 95% of patients accepting on-demand sedation. Average insertion time was 15 min with an average withdrawal time of 6 min. 145 (87M/58F) water-aided colonoscopies, completed for screening or surveillance were compared to a cohort of 145 (77M/68F) AI colonoscopies in the immediate prior period. The overall ADR of water-aided colonoscopy was 30% (43/145) with a proximal ADR of 21%. Using AI the overall ADR was 27.6% (40/145) with a proximal ADR of 14.5% (21/145). In males, the proximal colon ADR was 25% in water-aided colonoscopies and 14.3% using AI (p=0.0397).

CONCLUSIONS: Water-aided colonoscopy is feasible in a busy community practice with respectable cecal intubation rates. A large percentage of patients consenting to on-demand sedation completed without sedation. ADR in male subjects is consistent with similar prior reports of a significantly higher ADR in the proximal colon using WE when compared to AI.