TY - JOUR
T1 - Water Exchange Produces Significantly Higher Adenoma Detection Rate Than Water Immersion
T2 - Pooled Data from 2 Multisite Randomized Controlled Trials
AU - Leung, Felix W.
AU - Koo, Malcolm
AU - Cadoni, Sergio
AU - Falt, Premysl
AU - Hsieh, Yu His
AU - Amato, Arnaldo
AU - Erriu, Matteo
AU - Fojtik, Petr
AU - Gallittu, Paolo
AU - Hu, Chi Tan
AU - Leung, Joseph
AU - Liggi, Mauro
AU - Paggi, Silvia
AU - Radaelli, Franco
AU - Rondonotti, Emanuele
AU - Smajstrla, Vit
AU - Tseng, Chih Wei
AU - Urban, Ondrej
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Goals: To test the hypothesis that water exchange (WE) significantly increases adenoma detection rates (ADR) compared with water immersion (WI). Background: Low ADR was linked to increased risk for interval colorectal cancers and related deaths. Two recent randomized controlled trials of head-to-head comparison of WE, WI, and traditional air insufflation (AI) each showed that WE achieved significantly higher ADR than AI, but not WI. The data were pooled from these 2 studies to test the above hypothesis. Study: Two trials (5 sites, 14 colonoscopists) that randomized 1875 patients 1:1:1 to AI, WI, or WE were pooled and analyzed with ADR as the primary outcome. Results: The ADR of AI (39.5%) and WI (42.4%) were comparable, significantly lower than that of WE (49.6%) (vs. AI P=0.001; vs. WI P=0.033). WE insertion time was 3 minutes longer than that of AI (P<0.001). WE showed significantly higher detection rate (vs. AI) of the >10 mm advanced adenomas. Right colon combined advanced and sessile serrated ADR of AI (3.4%) and WI (5%) were comparable and were significantly lower than that of WE (8.5%) (vs. AI P<0.001; vs. WI P=0.039). Conclusions: Compared with AI and WI, the superior ADR of WE offsets the drawback of a significantly longer insertion time. For quality improvement focused on increasing adenoma detection, WE is preferred over WI. The hypothesis that WE could lower the risk of interval colorectal cancers and related deaths should be tested.
AB - Goals: To test the hypothesis that water exchange (WE) significantly increases adenoma detection rates (ADR) compared with water immersion (WI). Background: Low ADR was linked to increased risk for interval colorectal cancers and related deaths. Two recent randomized controlled trials of head-to-head comparison of WE, WI, and traditional air insufflation (AI) each showed that WE achieved significantly higher ADR than AI, but not WI. The data were pooled from these 2 studies to test the above hypothesis. Study: Two trials (5 sites, 14 colonoscopists) that randomized 1875 patients 1:1:1 to AI, WI, or WE were pooled and analyzed with ADR as the primary outcome. Results: The ADR of AI (39.5%) and WI (42.4%) were comparable, significantly lower than that of WE (49.6%) (vs. AI P=0.001; vs. WI P=0.033). WE insertion time was 3 minutes longer than that of AI (P<0.001). WE showed significantly higher detection rate (vs. AI) of the >10 mm advanced adenomas. Right colon combined advanced and sessile serrated ADR of AI (3.4%) and WI (5%) were comparable and were significantly lower than that of WE (8.5%) (vs. AI P<0.001; vs. WI P=0.039). Conclusions: Compared with AI and WI, the superior ADR of WE offsets the drawback of a significantly longer insertion time. For quality improvement focused on increasing adenoma detection, WE is preferred over WI. The hypothesis that WE could lower the risk of interval colorectal cancers and related deaths should be tested.
KW - adenoma detection rate (ADR)
KW - air insufflation (AI)
KW - water exchange (WE)
KW - water immersion (WI)
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U2 - 10.1097/MCG.0000000000001012
DO - 10.1097/MCG.0000000000001012
M3 - Article
C2 - 29505552
AN - SCOPUS:85046398562
VL - 53
SP - 204
EP - 209
JO - Journal of Clinical Gastroenterology
JF - Journal of Clinical Gastroenterology
SN - 0192-0790
IS - 3
ER -