Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies

Lorenzo Fuccio, Leonardo Frazzoni, Cesare Hassan, Marina La Marca, Valentina Paci, Veronica Smania, Nicola De Bortoli, Franco Bazzoli, Alessandro Repici, Douglas Rex, Sergio Cadoni

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20 Scopus citations

Abstract

Background and Aims: Water-aided colonoscopy techniques, such as water immersion (WI) and water exchange (WE), have shown different results regarding adenoma detection rate (ADR). We determined the impact of WI and WE on ADR and other procedural outcomes versus gas (air, AI; CO2) insufflation colonoscopy. Methods: A systematic search of multiple databases for randomized controlled trials comparing WI and/or WE with AI and/or CO2 and reporting ADR was conducted. A network meta-analysis with mixed comparisons was performed. Primary outcome was ADR (overall, in the right side of the colon and by colonoscopy indication). Results: Seventeen randomized controlled trials (10,350 patients) were included. WE showed a significantly higher overall ADR versus WI (odds ratio [OR], 1.31; 95% credible interval [CrI], 1.12-1.55) versus AI (OR, 1.40; CrI, 1.22-1.62) versus CO2 (OR, 1.48; 95% CrI, 1.15-1.86). WE achieved the highest ADR also in the right side of the colon and in colorectal cancer screening cases (both significant vs AI and WI) as well as in patients taking a split-dose preparation (significant vs all the other techniques). The Boston Bowel Preparation Scale cleanliness score (vs AI and WI) was significantly higher for WE. Both WI and WE showed increased proportion of unsedated examinations and decreased real-time insertion pain, with WE being the least-painful insertion technique. Withdrawal time was comparable across techniques, but WE showed the longest insertion time (3-5 additional minutes). Conclusions: WE significantly increases overall ADR, ADR in screening cases, and in the right side of the colon; it also improves colon cleanliness but requires a longer insertion time.

Original languageEnglish (US)
Pages (from-to)589-597.e11
JournalGastrointestinal endoscopy
Volume88
Issue number4
DOIs
StatePublished - Oct 2018

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Fuccio, L., Frazzoni, L., Hassan, C., La Marca, M., Paci, V., Smania, V., De Bortoli, N., Bazzoli, F., Repici, A., Rex, D., & Cadoni, S. (2018). Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies. Gastrointestinal endoscopy, 88(4), 589-597.e11. https://doi.org/10.1016/j.gie.2018.06.028