Water Exchange Produces Significantly Higher Adenoma Detection Rate Than Water Immersion: Pooled Data from 2 Multisite Randomized Controlled Trials

Felix W. Leung, Malcolm Koo, Sergio Cadoni, Premysl Falt, Yu His Hsieh, Arnaldo Amato, Matteo Erriu, Petr Fojtik, Paolo Gallittu, Chi Tan Hu, Joseph Leung, Mauro Liggi, Silvia Paggi, Franco Radaelli, Emanuele Rondonotti, Vit Smajstrla, Chih Wei Tseng, Ondrej Urban

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)204-209
Number of pages6
JournalJournal of Clinical Gastroenterology
Volume53
Issue number3
DOIs
StatePublished - Mar 1 2019

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Immersion
Adenoma
Randomized Controlled Trials
Water
Insufflation
Air
Colorectal Neoplasms

Keywords

  • adenoma detection rate (ADR)
  • air insufflation (AI)
  • water exchange (WE)
  • water immersion (WI)

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Water Exchange Produces Significantly Higher Adenoma Detection Rate Than Water Immersion : Pooled Data from 2 Multisite Randomized Controlled Trials. / Leung, Felix W.; Koo, Malcolm; Cadoni, Sergio; Falt, Premysl; Hsieh, Yu His; Amato, Arnaldo; Erriu, Matteo; Fojtik, Petr; Gallittu, Paolo; Hu, Chi Tan; Leung, Joseph; Liggi, Mauro; Paggi, Silvia; Radaelli, Franco; Rondonotti, Emanuele; Smajstrla, Vit; Tseng, Chih Wei; Urban, Ondrej.

In: Journal of Clinical Gastroenterology, Vol. 53, No. 3, 01.03.2019, p. 204-209.

Research output: Contribution to journalArticle

Leung, FW, Koo, M, Cadoni, S, Falt, P, Hsieh, YH, Amato, A, Erriu, M, Fojtik, P, Gallittu, P, Hu, CT, Leung, J, Liggi, M, Paggi, S, Radaelli, F, Rondonotti, E, Smajstrla, V, Tseng, CW & Urban, O 2019, 'Water Exchange Produces Significantly Higher Adenoma Detection Rate Than Water Immersion: Pooled Data from 2 Multisite Randomized Controlled Trials', Journal of Clinical Gastroenterology, vol. 53, no. 3, pp. 204-209. https://doi.org/10.1097/MCG.0000000000001012
Leung, Felix W. ; Koo, Malcolm ; Cadoni, Sergio ; Falt, Premysl ; Hsieh, Yu His ; Amato, Arnaldo ; Erriu, Matteo ; Fojtik, Petr ; Gallittu, Paolo ; Hu, Chi Tan ; Leung, Joseph ; Liggi, Mauro ; Paggi, Silvia ; Radaelli, Franco ; Rondonotti, Emanuele ; Smajstrla, Vit ; Tseng, Chih Wei ; Urban, Ondrej. / Water Exchange Produces Significantly Higher Adenoma Detection Rate Than Water Immersion : Pooled Data from 2 Multisite Randomized Controlled Trials. In: Journal of Clinical Gastroenterology. 2019 ; Vol. 53, No. 3. pp. 204-209.
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abstract = "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.",
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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

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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.

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