Water exchange versus air insufflation for colonoscopy: A meta-analysis

Area of Science:

• Gastroenterology
• Endoscopy
• Medical Technology

Background:

• Colonoscopy is a key tool for colorectal cancer screening and diagnosis.
• Conventional colonoscopy uses air insufflation (AI), which can cause patient discomfort.
• Water exchange (WE) is an alternative insufflation technique aiming to improve patient tolerance and visualization.

Purpose of the Study:

• To compare the efficacy and patient acceptance of the water exchange (WE) method versus the conventional air insufflation (AI) method for colonoscopy.
• To evaluate differences in technical quality, screening effectiveness, and patient-reported outcomes between WE and AI colonoscopy.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials.
• Included 13 studies with 7056 patients comparing WE and AI colonoscopy.
• Assessed outcomes using weighted mean difference (WMD) and relative risk (RR) with 95% confidence intervals (CI).

Main Results:

• WE colonoscopy showed significantly higher adenoma detection rates (ADR) (RR=1.28) and polyp detection rates (PDR) (RR=1.30) compared to AI.
• Patients undergoing WE reported significantly less pain (WMD=-1.99) and reduced need for sedation and repositioning.
• Cecal intubation time was longer with WE (WMD=1.56), but patient willingness to repeat the procedure was higher (RR=1.14).

Conclusions:

• The water exchange (WE) method is superior to air insufflation (AI) for improving adenoma and polyp detection rates during colonoscopy.
• WE significantly enhances patient acceptance by reducing pain, discomfort, and the need for sedation.
• Despite a slightly longer intubation time, WE offers substantial benefits in colonoscopy efficacy and patient experience.