Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Water Exchange vs CO2 Insufflation Colonoscopy: Right-Sided Colon Adenoma and Serrated Polyp Miss Rates
TAKE-HOME MESSAGE
- This randomized controlled trial compared water exchange (WE) colonoscopy with colonoscopy with CO2 insufflation. The main outcome was a combination of right-sided colon adenoma miss rate and right-sided serrated polyp miss rate (rSPMR). A total of 386 patients were randomized 1:1 to WE or CO2 insufflation. WE significantly decreased the combined right-sided colon adenoma miss rate and rSPMR and rSPMR alone compared with CO2 insufflation. The presence of two or more serrated polyps in the right colon was an independent predictor of rSPMR. A higher Boston Bowel Preparation Scale score in the right colon was associated with decreased rSPMR.
- This study suggests that WE significantly decreased the rSPMR and was associated with a higher Boston Bowel Preparation Scale scores in the right colon. WE colonoscopy is a viable alternative to colonoscopy with CO2 insufflation.
abstract
This abstract is available on the publisher's site.
Access this abstract nowINTRODUCTION
Postcolonoscopy colorectal cancers primarily occur in the right-sided colon because of missed adenomas and serrated polyps (SPs). Water exchange (WE) improves cleanliness and visibility of the right-sided colon. We hypothesized that WE could reduce the right-sided colon adenoma (rAMR) and SP miss rate (rSPMR) compared to standard colonoscopy.
METHODS
We randomly assigned 386 colonoscopy patients to insertion with either WE or CO2 insufflation. During the first withdrawal, polypectomies were performed up to the hepatic flexure. A second endoscopist, blinded to the insertion technique, reexamined the right-sided colon. The miss rate was determined by dividing the number of additional adenomas or SPs by the total number detected in both examinations. The primary outcome was the combined rAMR and rSPMR.
RESULTS
WE significantly decreased the combined rAMR and rSPMR (22.2% vs 32.2%, P < 0.001) and rSPMR alone (22.5% vs 37.1%, P = 0.002) compared to CO2 insufflation, but not rAMR (21.8% vs 29.8%, P = 0.079). Additionally, WE significantly increased the detection of SP per colonoscopy (SPPC) in the right-sided colon (0.95 ± 1.56 vs 0.50 ± 0.79, P < 0.001). Multivariate logistic regression analysis showed that ≥2 SPs in the right-sided colon was an independent predictor of rSPMR (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.89─6.38), along with a higher right-sided colon Boston Bowel Preparation Scale score (OR, 0.55; 95% CI, 0.32─0.94).
CONCLUSIONS
The significant reduction in rSPMR and increase in right-sided colon SPPC suggest that colonoscopy insertion using WE is a valid alternative to CO2 insufflation (Clinical trial registration number: NCT04124393).
Additional Info
Disclosure statements are available on the authors' profiles:
Comparing Right-sided Colon Adenoma and Serrated Polyp Miss Rates with Water Exchange and CO2 Insufflation: A Randomized Controlled Trial
Am. J. Gastroenterol 2024 Oct 30;[EPub Ahead of Print], CL Cheng, JH Tang, YH Hsieh, YL Kuo, KC Fang, CW Tseng, IC Su, CC Chang, YN Tsui, BP Lee, KY Zou, YS Lee, FW LeungFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.