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

Joseph Leung, Surinder K Mann, Rodelei Siao-Salera, Kanat Ransibrahmanakul, Brian Lim, Hazel Cabrera, Wilhemina Canete, Paul Barredo, Rebeck Gutierrez, Felix W. Leung

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background: Pilot studies using a novel water method to perform screening colonoscopy allowed patients to complete colonoscopy without sedation medications and also significantly increased the cecal intubation success rate. Objective: To perform a randomized, controlled trial comparing air insufflation (conventional method) and water infusion in lieu of air insufflation(study method) colonoscopy in minimally sedated patients. Hypothesis: Compared with the conventional method, patients examined by the study method had lower pain scores and required less medication but had a similar cecal intubation rate and willingness to undergo colonoscopy in the future. Setting: Outpatient colonoscopy in a single Veterans Affairs hospital. Methods: After informed consent and standard bowel preparation, patients received premedications administered as 0.5-increments of fentanyl (25 μg) and 0.5-increments of Versed (midazolam) (1 mg) plus 50 mg of diphenhydramine. The conventional and the study methods for colonoscopy were implemented as previously described. Additional pain medications were administered at the patients' request. Main Outcome Measurements: Increments of medications, pain scores, cecal intubation, and willingness to repeat colonoscopy. Results: Increments of medications used before reaching the cecum (1.6 ± 0.2 vs 2.4 ± 0.2, P < .0027), total increments used (1.8 ± 0.2 vs 2.5 ± 0.2, P < .014), and the maximum pain scores (1.3 ± 0.3 vs 4.1 ± 0.6, P < .0002) were significantly lower with the water method. Cecal intubation rate (100%) and willingness to undergo a repeat colonoscopy (96%) were similar. Limitations: Single Veterans Affairs hospital, older male population. Conclusion: Water infusion in lieu of air insufflation is superior to air insufflation during colonoscopy in the minimally sedated patients (ClinicalTrials.gov Identifier NCT00785889).

Original languageEnglish (US)
Pages (from-to)505-510
Number of pages6
JournalGastrointestinal Endoscopy
Volume70
Issue number3
DOIs
StatePublished - Sep 2009
Externally publishedYes

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Insufflation
Colonoscopy
Early Detection of Cancer
Colorectal Neoplasms
Air
Water
Intubation
Veterans Hospitals
Pain
Midazolam
Diphenhydramine
Premedication
Cecum
Fentanyl
Informed Consent
Outpatients
Randomized Controlled Trials

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

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. / Leung, Joseph; Mann, Surinder K; Siao-Salera, Rodelei; Ransibrahmanakul, Kanat; Lim, Brian; Cabrera, Hazel; Canete, Wilhemina; Barredo, Paul; Gutierrez, Rebeck; Leung, Felix W.

In: Gastrointestinal Endoscopy, Vol. 70, No. 3, 09.2009, p. 505-510.

Research output: Contribution to journalArticle

Leung, Joseph ; Mann, Surinder K ; Siao-Salera, Rodelei ; Ransibrahmanakul, Kanat ; Lim, Brian ; Cabrera, Hazel ; Canete, Wilhemina ; Barredo, Paul ; Gutierrez, Rebeck ; Leung, Felix W. / 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. In: Gastrointestinal Endoscopy. 2009 ; Vol. 70, No. 3. pp. 505-510.
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abstract = "Background: Pilot studies using a novel water method to perform screening colonoscopy allowed patients to complete colonoscopy without sedation medications and also significantly increased the cecal intubation success rate. Objective: To perform a randomized, controlled trial comparing air insufflation (conventional method) and water infusion in lieu of air insufflation(study method) colonoscopy in minimally sedated patients. Hypothesis: Compared with the conventional method, patients examined by the study method had lower pain scores and required less medication but had a similar cecal intubation rate and willingness to undergo colonoscopy in the future. Setting: Outpatient colonoscopy in a single Veterans Affairs hospital. Methods: After informed consent and standard bowel preparation, patients received premedications administered as 0.5-increments of fentanyl (25 μg) and 0.5-increments of Versed (midazolam) (1 mg) plus 50 mg of diphenhydramine. The conventional and the study methods for colonoscopy were implemented as previously described. Additional pain medications were administered at the patients' request. Main Outcome Measurements: Increments of medications, pain scores, cecal intubation, and willingness to repeat colonoscopy. Results: Increments of medications used before reaching the cecum (1.6 ± 0.2 vs 2.4 ± 0.2, P < .0027), total increments used (1.8 ± 0.2 vs 2.5 ± 0.2, P < .014), and the maximum pain scores (1.3 ± 0.3 vs 4.1 ± 0.6, P < .0002) were significantly lower with the water method. Cecal intubation rate (100{\%}) and willingness to undergo a repeat colonoscopy (96{\%}) were similar. Limitations: Single Veterans Affairs hospital, older male population. Conclusion: Water infusion in lieu of air insufflation is superior to air insufflation during colonoscopy in the minimally sedated patients (ClinicalTrials.gov Identifier NCT00785889).",
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AU - Siao-Salera, Rodelei

AU - Ransibrahmanakul, Kanat

AU - Lim, Brian

AU - Cabrera, Hazel

AU - Canete, Wilhemina

AU - Barredo, Paul

AU - Gutierrez, Rebeck

AU - Leung, Felix W.

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AB - Background: Pilot studies using a novel water method to perform screening colonoscopy allowed patients to complete colonoscopy without sedation medications and also significantly increased the cecal intubation success rate. Objective: To perform a randomized, controlled trial comparing air insufflation (conventional method) and water infusion in lieu of air insufflation(study method) colonoscopy in minimally sedated patients. Hypothesis: Compared with the conventional method, patients examined by the study method had lower pain scores and required less medication but had a similar cecal intubation rate and willingness to undergo colonoscopy in the future. Setting: Outpatient colonoscopy in a single Veterans Affairs hospital. Methods: After informed consent and standard bowel preparation, patients received premedications administered as 0.5-increments of fentanyl (25 μg) and 0.5-increments of Versed (midazolam) (1 mg) plus 50 mg of diphenhydramine. The conventional and the study methods for colonoscopy were implemented as previously described. Additional pain medications were administered at the patients' request. Main Outcome Measurements: Increments of medications, pain scores, cecal intubation, and willingness to repeat colonoscopy. Results: Increments of medications used before reaching the cecum (1.6 ± 0.2 vs 2.4 ± 0.2, P < .0027), total increments used (1.8 ± 0.2 vs 2.5 ± 0.2, P < .014), and the maximum pain scores (1.3 ± 0.3 vs 4.1 ± 0.6, P < .0002) were significantly lower with the water method. Cecal intubation rate (100%) and willingness to undergo a repeat colonoscopy (96%) were similar. Limitations: Single Veterans Affairs hospital, older male population. Conclusion: Water infusion in lieu of air insufflation is superior to air insufflation during colonoscopy in the minimally sedated patients (ClinicalTrials.gov Identifier NCT00785889).

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