A Proof-of-Concept RCT to Confirm the Beneficial Effects of the Water Method on U.S. Veterans Undergoing Colonoscopy with the Option of On-demand Sedation

Abstract

Purpose: Whether the water method can facilitate completion of unsedated colonoscopy in patients who received sedation for prior colonoscopy is unknown. Sedation for colonoscopy imposes recovery time burden on patients (median 47 minutes onsite and 17.7 hours at home) (AJG 2007;102:2401). The objective of this abstract is to report the impact of the water method and on demand sedation on completion of unsedated colonoscopy and patient recovery time burden. Methods: Veterans accepting on demand sedation for screening or surveillance colonoscopy were randomized to air or water method for colonoscope insertion. Main outcome measurements: Completion of colonoscopy without sedation, onsite and at home recovery times. Results: 100 patients were randomized, 50/group. 27 in the air and 39 in the water group completed colonoscopy without requiring sedation (p<0.05, Fisher's exact test). Thirteen of the 100 patients had prior sedated colonoscopy requiring Midazolam 1-5 mg, Fentanyl 25-100 μg and Benadryl 50 mg. Ten of the 13 patients completed colonoscopy without sedation (3 in the air and 7 in the water group). The water method reduced onsite and at home recovery times (Tables 1). Table 2 lists the actual and hypothetical times saved. Limitations: Single VA site, predominantly male veterans, unblinded examiners.[1478] Table 1. Patient recovery time on site and at home[1478] Table 2. Actual and hypothetical patient recovery times savedConclusion: When veterans accepted the option of on demand sedation, the water method facilitated completion of unsedated colonoscopy, including those with a prior history of sedated colonoscopy, and reduced total patient onsite and at home recovery time burden.