Water Exchange (WE) and Quality Improvement - Enhanced Advanced Adenoma Detection: A Pooled Data Analysis of 6 Randomized Controlled Trials

Felix W. Leung, Malcolm Koo, Hui Jia, Joseph W. Leung, Sergio Cadoni, Premysl Falt, Yu Hsi Hsieh, Chi Tan Hu, Yanglin Pan, Franco Radaelli

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Advanced adenomas (≥10 mm in diameter, >25% villous, or high-grade dysplasia), a marker of colorectal cancer risk, are used to stratify patients for closer surveillance. Modern accessories, endoscopes, and age-adjusted evaluation have variable impacts on the advanced adenoma detection rate (AADR). In 1 randomized controlled trial (RCT) comparing air insufflation (AI) with water exchange (WE), the right colon AADR was significantly increased by WE. Four network meta-analyses reported that WE significantly increased overall adenoma detection rate (ADR), but the impact on AADR was not addressed. Aim: The aim of this study was to test the hypothesis that WE significantly increased AADR compared with AI. Method: Six Clinicaltrial.gov-registered RCTs were reported by a group of WE investigators. Data including AADR (primary outcome) and overall ADR (secondary outcome) were pooled. Results: A total of 5407 patients were randomized to AI (2699) and WE (2708). Compared with AI, WE significantly increased AADR (5.7% vs. 8.3%, P=0.001) and overall ADR (20.9% vs. 27.4%, P=0.001). Conclusions: In contrast to published reports, which showed variable impacts on AADR, WE was consistent in increasing AADR in 6 reported RCTs. The pooled data confirm that the impact of WE in increasing AADR was significant. The significantly enhanced overall ADR indicated that WE provided a higher quality outcome than AI. The significant improvement in AADR confirmed WE to be clinically relevant and has finally arrived as a timely addition to colorectal cancer prevention programs.

Original languageEnglish (US)
Article number0000131
JournalJournal of Clinical Gastroenterology
DOIs
StateAccepted/In press - Jan 1 2019

Keywords

  • advanced adenoma detection rate
  • air insufflation
  • overall adenoma detection rate
  • water exchange

ASJC Scopus subject areas

  • Gastroenterology

Fingerprint Dive into the research topics of 'Water Exchange (WE) and Quality Improvement - Enhanced Advanced Adenoma Detection: A Pooled Data Analysis of 6 Randomized Controlled Trials'. Together they form a unique fingerprint.

Cite this