Do Water-aided Techniques Improve Serrated Polyp Detection Rate During Colonoscopy?: A Systematic Review With...

Area of Science:

• Gastroenterology
• Endoscopic techniques
• Colorectal cancer screening

Background:

• Water-aided techniques (WT), including water exchange (WE) and water immersion (WI), are explored for enhancing colonoscopy outcomes.
• Serrated polyps are frequently missed during colonoscopy due to their location and appearance.
• Standard gas-assisted (GA) methods are compared against WT for polyp detection efficacy.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials (RCTs) comparing WT with GA methods.
• To assess the impact of WT on serrated polyp detection rate (SPDR) and sessile serrated polyp detection rate (SSPR).
• To determine if WT improves the detection of difficult-to-find serrated polyps.

Main Methods:

• Systematic review and meta-analysis of RCTs sourced from Medline, EMBASE, Cochrane Library, CINAHL, and Web of Sciences.
• Primary outcome: SPDR; Secondary outcomes: SSPR and cecal intubation rate.
• Statistical analysis included risk ratios (RRs) with a significance level of P < 0.05.

Main Results:

• Four RCTs with 5306 patients were included; 2571 received GA and 2735 received WT.
• WT significantly increased SPDR compared to GA (6.1% vs. 3.8%; RR, 1.63; P < 0.001).
• Subgroup analysis of WE also showed improved SPDR versus GA (4.9% vs. 3.2%; RR, 1.57; P = 0.004).

Conclusions:

• Water-aided techniques, particularly water exchange, enhance the detection of serrated polyps.
• WT should be considered in clinical practice to improve serrated polyp detection.
• Improved detection of serrated polyps may help prevent interval colorectal cancers.