Water Exchange Method Significantly Improves Adenoma Detection Rate: A Multicenter, Randomized Controlled Trial

Area of Science:

• Gastroenterology
• Endoscopy
• Clinical Quality Improvement

Background:

• Adenoma detection rate (ADR) is a critical quality metric for colonoscopy.
• Low ADR among Chinese endoscopists necessitates exploring novel techniques for performance enhancement.
• Western studies suggest water exchange (WE) may improve ADR, but require validation in diverse populations.

Purpose of the Study:

• To test the hypothesis that water exchange (WE) significantly increases ADR among Chinese colonoscopists.
• To design a prospective randomized controlled trial with ADR as the primary outcome.
• To compare the efficacy of WE versus traditional air insufflation (AI) in a Chinese cohort.

Main Methods:

• A prospective, randomized controlled trial conducted at six centers in China.
• 3,303 patients were randomized to either WE or AI for colonoscopy.
• The primary outcome measured was the adenoma detection rate (ADR).

Main Results:

• Overall ADR was significantly higher with WE (18.3%) compared to AI (13.4%) (RR 1.45, P<0.001).
• WE demonstrated a significant increase in ADR for screening and diagnostic colonoscopies.
• The benefit of WE was consistently observed across all indication categories and investigators.

Conclusions:

• Water exchange (WE) significantly improves ADR in Chinese colonoscopists, confirming Western findings.
• WE may be a superior method to air insufflation (AI) for colonoscopy screening in China.
• Endoscopists globally experiencing low ADR are encouraged to evaluate WE for potential performance improvement.