Abstract
A net-work meta-analysis (GIE. 2018;88:589) showed water exchange (WE) provided the highest adenoma detection rate (ADR). The impact on sessile serrated polyp detection rate (SSPDR) was not addressed. SSP have increased malignant potential (Curr Treat Options Gastroenterol. 2015;13:156). They have subtle appearance (AJG. 2012;107:1315). They cluster in the proximal colon (61%) (Arch Pathol Lab Med. 2015;139:388) co-localizing with interval cancers (64% to 68%) (Gastro. 2014;146:950; Cancer. 2012;118:3044). The finding of SSPs was mentioned in several RCTs comparing WE with air (AI) or carbon dioxide (CO2) insufflation. We test the hypothesis that compared with air (AI) or carbon dioxide (CO2) insufflation, water exchange (WE) could enhance the real-time detection of SSP. The aim is to assess the impact of WE (vs. AI or CO2) on SSPDR. Four reports with data on SSP and WE vs. AI or CO2 insufflation were identified. Demographic, procedural and SSP data were extracted, pooled and analyzed. By pooling the data in four RCTs the pitfall of type II error due to small sample size could be avoided. Table 1 summarizes the salient demographic and procedural features. Table 2 shows that the pooled SSPDR of WE (8.0%) was significantly higher than that of air or CO2 insufflation combined (5.0%) (p=0.0017, Fisher exact test). The combined data showed WE significantly increased SSPDR by 3%. With an estimated 19 million colonoscopies in the US in 2018 (https://idataresearch.com/an-astounding-19-million-colonoscopies-are-performed-annually-in-the-united-states/), 3.0% of 19 million (570,000) is clinically meaningful. The improved outcomes of increased SSPDR add value to WE colonoscopy. The improved value appears to justify consideration to incorporate WE into colorectal cancer prevention programs.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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