Water Infusion in Lieu of Air Insufflation and Suction Removal of Residual Air (Water Method) Significantly Increased the Proportion of Patients with a History of Abdominal Surgery Completing Unsedated Colonoscopy

Abstract

Purpose: Patients with a history of abdominal surgery other than segmental colonic resection have been considered to be subjects with “difficult” colonoscopy (World J Gastroenterol 2009; 15: 5186-92; Hepato-Gastroenterol 2007;54:1403-6; Eur J Gastroenterol Hepatol 2007; 19: 695-9; J Clin Gastroenterol 2006; 40: 711-6; Gastrointest Endosc 2002; 55: 838-41). The aim of this abstract is to provide data to determine if use of the water method significantly increases the proportion of patients with a history of abdominal surgery completing unsedated colonoscopy to the cecum. Methods: The water method was implemented by turning off the air pump prior to insertion of the colonoscope into the rectum. Residual air was suctioned to minimize angulations of flexures. Warm water was infused to minimize spasms and to assist in identification of the lumen. Residual fecal matter was aspirated before additional clean water was infused. Two RCT were conducted at two VA facilities to determine if the water method increased the proportion of patients who could complete colonoscopy to the cecum without sedation when the options of scheduled, unsedated without backup sedation (N=82, Sepulveda) or on demand sedation (N=100, Sacramento) was used. Patients' history of abdominal surgery and the maximum discomfort during colonoscopy were recorded. Results: Randomization revealed balanced demographic and clinical variables. The water method significantly decreased maximum discomfort during colonoscopy (Table 1). The proportion completing unsedated colonoscopy in the water group (19 of 22) was significantly higher than that (11 of 22) in the air group (p=0.0217, Fisher's exact test). Limitation: Elderly veteran population.[1382] Table 1. Mean maximum discomfort during colonoscopy in patients who did or did not achieve cecal intubation without receiving sedation using the air or water methodConclusion: The data derived from two RCT revealed that the water method significantly diminished the maximum discomfort during colonoscopy in patients with a previous history of abdominal surgery. The water method significantly increased the proportion of patients completing unsedated colonoscopy in these “difficult colonoscopy” subjects. RCT of the air vs. water method in patients with factors associated with difficult colonoscopy deserves to be supported (Supported in part by ACG clinical research award).