Endoscopy 2018; 50(04): S5
DOI: 10.1055/s-0038-1637672
ESGE Days 2018 oral presentations
20.04.2018 – Late breaking abstracts
Georg Thieme Verlag KG Stuttgart · New York

WATER EXCHANGE COLONOSCOPY INCREASES ADENOMA DETECTION RATE. A SYSTEMATIC REVIEW WITH NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED STUDIES

L Frazzoni
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
L Fuccio
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
C Hassan
2   Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
M La Marca
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
V Paci
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
V Smania
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
N De Bortoli
3   Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
,
F Bazzoli
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
A Repici
4   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Milan, Italy
,
D Rex
5   Division of Gastroenterology and Hepatology, Indiana University Hospital, Indianapolis, United States
,
S Cadoni
6   Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

Water-aided colonoscopy techniques (water immersion, WI; 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 vs. gas (air, AI; carbon dioxide, CO2) insufflation colonoscopy.

Methods:

Systematic search for randomized controlled trials comparing WI and/or WE with AI and/or CO2 and reporting ADR up to November 1st, 2017. We performed network meta-analysis with mixed comparisons. Primary outcome was ADR (overall, in the right colon and by colonoscopy indication).

Results:

We included 17 randomized controlled trials (10,350 patients). WE showed significantly higher overall ADR vs. WI [Odds Ratio, OR 1.31, (95% Credible Interval 1.12 – 1.55)], vs. AI [1.40 (1.22 – 1.62)] and vs. CO2 [1.48 (1.15 – 1.86)]. WE achieved higher ADR in the right colon than WI [1.36 (1.10 – 1.70)] and AI [1.54 (1.23 – 1.93)], and higher ADR in colorectal cancer screening cases than WI [1.4 (1.02 – 2.09)] and AI [1.48 (1.19 – 1.9)]. WE had higher ADR in split-dose patients than AI [1.43 (1.22 – 1.67)], CO2 [1.39 (1.05 – 1.85)] and WI [1.26 (1.04 – 1.51)]. Boston Bowel Preparation Scale cleanliness score was higher for WE than WI [mean difference, MD 0.41, (95% Credible Interval 0.04 – 0.78)] and AI [0.68 (0.34 – 1.02)]. WI and WE showed decreased real-time insertion pain vs. AI [WE vs. AI, -1.99 (-2.82, -1.21), and WI vs. AI, -1.54 (-2.37, -0.72)], with WE being the least painful technique. Withdrawal time was comparable across techniques, but WE showed longer insertion time vs. AI [2.62 (0.66 – 4.52)], vs. CO2 [3.3 (0.49 – 6.07)] and vs. WI [3.32 (1.03 – 5.58)].

Conclusions:

WE significantly increases overall ADR, ADR in CRC screening cases, ADR in split-dose regimens, and right colon ADR. It also improves colon cleanliness but requires longer insertion time. Until additional data will be available, WE should be considered superior to WI. Further research should address the impact of WE on interval cancer and related deaths.