Increase in proximal adenoma detection rate after transition from air to water method for screening colonoscopy in a community-based setting in the United States

Abstract

Background: The water method of colonoscopy has been shown to increase adenoma detection rate in the United states veteran population, but this has not yet been demonstrated in a non-veteran community setting in the United states. Aims: Our aim is to perform a retrospective study to compare adenoma detection rate between the air and the water colonoscopy methods for screening colonoscopies at a non-veteran community site. Methods: We performed a retrospective review of 100 patients from before and after a single community endoscopist transitioned from air colonoscopy to water colonoscopy. The patients selected were the 50 most recent patients who presented for air colonoscopy and the first 50 patients who underwent water colonoscopy after the transition. patients who presented for indications other than colon cancer screening or surveillance were excluded. The primary end point was overall adenoma detection rate; secondary end points included cecal intubation time, procedure time, polyp detection rate, proximal colon adenoma detection rate, and sedation requirement. Results: There was no significant difference between the two methods in total adenoma detection rate, polyp detection rate, cecal intubation time, total procedure time, or sedation requirement. however, there was a significantly higher proximal adenoma detection rate (34%) with the water method compared to the air method (18%), p=0.015. Conclusion: In a non-veteran community setting, screening colonoscopy done with the water method resulted in a significantly higher proximal colon adenoma detection rate without significantly adding to total procedure time or sedation requirement.