Objective: a proof-of-principle randomized controlled trial (RcT) evaluated a novel water exchange method in scheduled unsedated veterans. Insertion was conducted with deliberate caution to obviate avoidable discomfort. Despite favorable patient outcomes, the prolonged insertion time was deemed a hurdle to widespread adoption of the method in busy practice models. Using the subsequently time-tested method we reassessed the impacts of water exchange. Methods This was a prospective, R cT (NcT01383252) conducted at an outpatient endoscopy suite at the sacramento VaMc. 100 consecutive veterans who requested scheduled unsedated screening colonoscopy were randomized to water exchange vs. air method to aid insertion. The main outcome measurements were demographic, patient and procedurerelated variables. Results: 90 of 100 randomized patients requested scheduled unsedated colonoscopy due to lack of escort. Intention-totreat cecal intubation rate was 98% (water) vs. 88% (air), p=0.2687. During insertion there was a significantly lower mean (sD) maximum pain score 3 (2.8) vs. 5 (3.0) (p=0.0008) in the water exchange group. Willingness to repeat: 76% vs. 48% (p<0.0007, Fisher’s exact test) was superior with water exchange. Insertion times (min) were comparable 13 (6.7) (water) vs. 12 (7.0) (air) (p=0.4673). Overall (54% vs. 48%), proximal (40% vs. 28%) and proximal <10 mm (36% vs. 28%) aDR were in favor of water exchange. Limitations: single Va site, predominantly male patients and unblinded examiners. Conclusions: Relevant to concerns in busy practice models, when the established and time-tested water exchange method is used, the favorable impacts on patient-centered outcomes are no longer at the expense of excessively prolonged procedural times.
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Joseph W. Leung (2013) studied this question.
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