The water exchange method for colonoscopy-effect of coaching

Area of Science:

• Gastroenterology
• Endoscopy

Background:

• Water immersion colonoscopy is an established technique, often used with air insufflation.
• Water exchange is a novel modification of water immersion designed to minimize patient discomfort during unsedated colonoscopies.
• This technique requires efficient water removal during insertion to maintain low distension and facilitate cleansing, a step perceived as challenging.

Purpose of the Study:

• To assess the impact of direct verbal coaching on the intention-to-treat cecal intubation rate using the water exchange method.
• To evaluate the feasibility and effectiveness of water exchange colonoscopy in a U.S. patient population.

Main Methods:

• An observational study involving experienced colonoscopists performing water exchange colonoscopy.
• Direct verbal coaching was provided to facilitate understanding and mastery of the technique's nuances.
• Primary outcome measured was intention-to-treat cecal intubation; secondary outcomes included patient comfort, adenoma detection, and bowel preparation quality.

Main Results:

• 74% of experienced colonoscopists achieved 100% intention-to-treat cecal intubation.
• The overall intention-to-treat cecal intubation rate was 88% (90% male, 87% female).
• Conversion to air insufflation was occasionally necessary, with a high completion rate (98%); poor bowel preparation was infrequent (2.7%).

Conclusions:

• Direct verbal coaching can facilitate the adoption and understanding of the water exchange colonoscopy method.
• Water exchange is a feasible technique that can achieve high cecal intubation rates, even with occasional conversion to air insufflation.
• Further studies on individual learning curves are needed to optimize proficiency with this water immersion technique.