Assessing water-assisted colonoscopy in beginner endoscopists: a randomised controlled trial

Area of Science:

• Gastroenterology
• Endoscopy
• Medical Training

Background:

• Colonoscopy is a key diagnostic tool, but its learning curve can be challenging for novice endoscopists.
• Conventional carbon dioxide (CC) insufflation is standard, but water-assisted colonoscopy (WAC) using the water immersion technique is an emerging alternative.
• Optimizing training methods is crucial for improving colonoscopy proficiency and patient outcomes.

Purpose of the Study:

• To compare the efficacy and safety of water-assisted colonoscopy (WAC) versus conventional carbon dioxide colonoscopy (CC) in novice endoscopists.
• To evaluate procedure time, learning curves, and patient-reported outcomes between WAC and CC.
• To determine if WAC is a viable alternative for gastroenterology training programs.

Main Methods:

• A prospective, randomized (1:1) single-centre trial involving six gastroenterology fellows with fewer than 150 prior colonoscopies.
• Standardized training was provided for both WAC and CC techniques.
• Patients were randomly assigned to undergo screening colonoscopies using either WAC or CC, with caecal intubation time (CIT) as the primary outcome.

Main Results:

• Mean caecal intubation time (CIT) was comparable between WAC (10.6±4.2 min) and CC (9.8±3.9 min) groups (p=0.35).
• Technical failure rates (6.2% WAC vs 5.1% CC), procedural difficulty, analgesic requirements, and patient discomfort scores were similar between the groups.
• Adenoma detection rates (ADR) were also comparable (40.7% WAC vs 33.3% CC; p=0.25), and learning curves showed parallel improvements in CIT for both techniques.

Conclusions:

• Water-assisted colonoscopy (WAC) presents a safe and effective alternative to conventional carbon dioxide colonoscopy (CC) for novice endoscopists.
• WAC demonstrates similar procedure times, learning curves, and safety profiles compared to CC.
• These findings advocate for the integration of WAC into gastroenterology training curricula to enhance endoscopic skills acquisition.