Minimal Oral Water Immersion Method May Shorten Insertion Time During Unsedated Colonoscopy: A Randomized Controlled...

Unsedated colonoscopy often increases procedural pain and prolongs insertion time, especially in the sigmoid colon with acute luminal angulation. This study aimed to evaluate the efficacy and safety of preprocedural enhanced oral water intake (PWI) for unsedated colonoscopy.

This randomized controlled trial (RCT) enrolled 372 eligible patients. They were randomized to the conventional air colonoscopy (CAC), water-assisted colonoscopy (WAC), and PWI groups to receive the assigned interventions. Primary outcomes included insertion time, visual analog scale (VAS), cecal intubation rate, bowel cleanliness, and adenoma detection rate (ADR).

All 3 groups achieved a cecal intubation rate of 100.0%. The ADR was comparable among the 3 groups, with no statistically significant difference (P=0.702). VAS scores in the CAC group were significantly higher than those in the WAC and PWI groups (4.15±1.68 vs. 2.64±1.99 and 2.65±1.97; P<0.001, 95% CI: 1.049-1.968 and 95% CI: 1.035-1.949), whereas no statistically significant difference was found between the WAC and PWI groups (P=0.949, 95% CI: -0.510 to 0.478). Compared with CAC (2.00 min) and WAC (2.55 min), the PWI group exhibited a shorter median insertion time (1.60 min, all P<0.001). The Hodges-Lehmann median differences were -0.80 minutes (95% CI: -1.00 to -0.50 min, PWI vs. CAC) and 1.20 minutes (95% CI: 1.00-1.50 min, WAC vs. PWI). Willingness to undergo repeat colonoscopy was comparable between WAC and PWI (P=0.820), but significantly higher in these 2 groups than in the CAC group (P=0.017).

PWI appears to be associated with shorter insertion time among patients undergoing unsedated colonoscopy.