Background: There is emerging US acceptance of up-front scheduled unsedated colonoscopy particularly when communication with clinicians and procedural convenience are highly valued (FW Leung et al GIE, in press). A novel method of water infusion in lieu of air insufflation during colonoscope insertion permitted 52% of patients who accepted sedation on-demand to complete colonoscopy without sedation (JW Leung et al APT 2007;26:627-631) compared with 23% (Petrini et al GIE 2007;65(5):AB357) and 34% (Terruzzi et al GIE 2001;54:169-74) when usual air insufflation was used (p < 0.05, Chi Square), suggesting the novel method enhanced performance. Aim: To determine the effect of this novel method of water infusion in lieu of air insufflation in up-front scheduled unsedated colonoscopy. Site: VA Sepulveda Ambulatory Care Center. Design: Prospective, non-randomized, consecutive group, performance improvement project. Techniques: 2 methods for inserting the colonoscope were used. Air insufflation was used during withdrawal in both periods. Usual method (7/05-6/06): judicious air insufflation. Study method (7/06-11/07): infusion of water in lieu of air insufflation during colonoscope insertion and suction of residual water during withdrawal. Primary outcome: cecal intubation rate. Secondary outcomes: proportion of patients rescheduled due to poor bowel preparation, need for abdominal compression, patient report of good current experience and willingness to repeat unsedated colonoscopy. Results: Quality (cecal intubation rate; satisfactory bowel preparation for completing examination, need for abdominal compression) and patient satisfaction (report of willingness to repeat unsedated colonoscopy) were significantly better with the novel method. Conclusion: Compared with usual air insufflation, the novel method of water infusion in lieu of air insufflation during colonoscope insertion resulted in significantly improved quality and patient satisfaction in up-front scheduled unsedated colonoscopy in US veterans. Tabled 1Comparison of usual air insufflation vs water infusion in lieu of air insufflation. Up-front Scheduled Unsedated Usual Air Insufflation Water Infusion in Lieu of Air Project period ∗ No complications in either period. 7/05-6/06 7/06-11/07 Total number 62 66 Incomplete due to poor bowel prep 8 (12.9% of 62) 1 (1.5% of 66) † Vs usual air insufflation, Chi Square, p < 0.05. Satisfactory bowel prep 54 (87.1% of 62) 65 (98.5% of 66) † Vs usual air insufflation, Chi Square, p < 0.05. Incomplete due to discomfort 7 (13.0% of 54) 2 (3.0% of 65) † Vs usual air insufflation, Chi Square, p < 0.05. Abdominal compression applied 43 (79.6% of 54) 21 (32.3% of 65) † Vs usual air insufflation, Chi Square, p < 0.05. Successful cecal intubation 47 (87.0% of 54) 63 (96.9% of 65) † Vs usual air insufflation, Chi Square, p < 0.05. Good experience 41 (75.9% of 54) 55 (84.6% of 65) † Vs usual air insufflation, Chi Square, p < 0.05. Willing to repeat 42 (77.8% of 54) 60 (92.3% of 65) † Vs usual air insufflation, Chi Square, p < 0.05. ∗ No complications in either period. † Vs usual air insufflation, Chi Square, p < 0.05. Open table in a new tab