Warm Water Infusion Research Articles

An Ethnomedicinal Study; Joint Pain Therapy by Traditional Healers of Solo City

Healers of Jamu- a Traditional Medicine in Solo City, Central Java, Indonesia apply several therapies for treatment of different diseases, including joint pain. The aim of the ethnomedicinal study is the identification of herbal formulations/ medicinal plants/method of preparation and their mode of administration for joint pain therapy in Jamu Medicine. An ethnomedicinal survey was conducted to collect data from traditional healers of Jamu Medicine regarding the practice of joint pain therapy. Data was collected from 25 healers through interview by snowball technique. The data obtained from the study revealed that, 25 herbal formulations /potions consisting of 32 types of medicinal plants from 19 families have been registered by traditional healers for joint pain therapy. Most commonly used plants for joint pain therapy have been identified as Piper retrofractum Vahl, Zingiber officinale Roscoe, Curcuma xanthorrhiza D.Dietr., Kaempferia galanga L., and Curcuma longa L. Traditional herbal formulations are prepared by different processing methods like washing, peeling, crushing, pounding then squeezing with warm water (infusion)/ boiling in water (decoction) to get their extract. These herbal formulations are administered orally or applied locally as massage on the affected joint. Through this study we will preserve the traditional knowledge of Jamu Medicine because the younger generation of traditional healers is no more interested in continuing it and their number is gradually decreasing. This valuable data will help the scientist to make new medicinal breakthroughs in the future especially to treat joint pain.

Https://www.zentimepublishing.com/journal/PMD/issues/Vol1Iss1/10.61189/550253gnnvtv.html

In recent years, the importance of endoscopic procedures has risen significantly in response to the escalating prevalence of digestive system diseases. The gastroenteroscopic technique has undergone several iteration and updates; however, challenges related to patient pain remain an ongoing concern. As a result, patients satisfaction with this examination method is still low. Based on this, research has been focusing on assistive technologies that work with endoscopy to increase patient tolerance. The technologies listed in this review inculde sedation, acupoint stimulation, recumbent changes, gas-filled assistance, warm water infusion assistance, and distraction.

Water infusion versus air insufflation during the insertion phase of unsedated colonoscopy: a single-center single blind randomized controlled trial

Objective To compare effects of warm water infusion and air insufflation on patient tolerance and satisfaction during the insertion phase of unsedated colonoscopy. Methods In a single-center, prospective, single blind randomized trial, patients were randomly assigned to three groups (water infusion group, air insufflation group, or hybrid method group) during the insertion phase of colonoscopy. Main outcome measurements included insertion time, cecal intubation rate, adenoma detection rate, the rate of position change, the rate of abdominal compression, intraoperative pain and distension VAS scores, postoperative pain and distension VAS scores. Results A total of 180 cases were enrolled, 60 in each group. Patients in water infusion group and hybrid method group required less abdominal compression or position change, longer insertion time, reported lower intraoperative pain and distension VAS scores than air insufflation group during the insertion phase of colonoscopy. There were no significant differences in cecal intubation rates, adenoma detection rates, postoperative pain and distension or VAS scores among three groups. Conclusion Water infusion significantly decreases patient abdominal pain and distension during the insertion phase of colonoscopy without affecting cecal intubation rate and adenoma detection rate. Key words: Colonoscopy; Self tolerance; Air insufflation; Water infusion

Carbon dioxide insufflation or warm-water infusion for unsedated colonoscopy: A randomized controlled trial in patients with chronic constipation in China.

Aims:The effect of carbon dioxide (CO2) insufflation and warm-water infusion during colonoscopy on patients with chronic constipation remains unknown. We evaluated CO2 insufflation and warm-water irrigation versus air insufflation in unsedated patients with chronic constipation in China.Patients and Methods:This randomized, single–center, controlled trial enrolled 287 consecutive patients, from January 2014 to January 2015, who underwent colonoscopy for chronic constipation. Patients were randomized to CO2 insufflation, warm-water irrigation and air insufflation colonoscopy insertion phase groups. Pain scores were assessed by the visual analog scale (VAS). The primary outcome was real-time maximum insertion pain, recorded by an unblinded nurse assistant. At discharge, the recalled maximum insertion pain was recorded. Meanwhile, patients were requested to select the VAS at 0, 10, 30, and 60 min after the procedure. In addition, cecal intubation and withdrawal time, total procedure time, and adjunct measures were recorded.Results:A total of 287 patients were randomized. The correlation between real-time and recalled maximum insertion pain ((Pearson coefficient r = 0.929; P < 0.0001) confirmed internal validation of the primary outcome. The mean real-time maximum pain scores during insertion 2.9 ± 2.1 for CO2, 2.7 ± 1.9 for water achieved a significantly lower pain score compared with air (5.7 ± 2.5) group (air vs CO2 P < 0.001; air vs water P < 0.001). However, no significant pain score differences were found between the patients in the CO2 and water groups (CO2 vs water, P = 0.0535). P values in painless colonoscopy and only discomfort colonoscopy (pain 1–2) were, respectively, 6 (6.4%) and 8 (8.5%) for air; 17 (17.7%) and 29 (30.2%) for CO2; 16 (16.5%) and 31 (31.9%) for water. At 0, 10, 30, and 60 min postprocedure, pain scores showed in the CO2 and water groups had significantly reduced than in air group. Insertion time was significantly different between air (10.6 ± 2.5) and CO2 (7.2 ± 1.4) (air vs CO2 P < 0.001), air and water (6.9 ± 1.3) (air vs water P < 0.001). However, CO2 and was not significantly different in cecum-intubated time (CO2 vs water, P = 0.404). CO2 and water group in extubation time were significantly different, respectively, CO2 (7.9 ± 1.1) and water (8.0 ± 1.1) (CO2 vs water, P = 0.707). CO2 or water group required less implementation of adjunct measures and more willingness to repeat the procedure.Conclusions:Compared with air, the CO2 or water-aided method reduced real-time maximum pain and cecum-intubated time for chronic constipated patients in unsedated colonoscopy. The CO2 insufflation or warm-water irrigation may be a simple and inexpensive way to reduce discomfort in unsedated patients with constipation. This study demonstrated an advantage of using CO2 insufflation and warm-water irrigation during colonoscopy in unsedated constipated patients in China.

Comparison of Modified Warm Water Infusion and Air Insufflation for Colonoscopy in A Rat Colon Cancer Model

Comparison of Modified Warm Water Infusion and Air Insufflation for Colonoscopy in A Rat Colon Cancer Model

Carbon Dioxide Insufflation or Warm-Water Infusion Versus Standard Air Insufflation for Unsedated Colonoscopy

The increasing demand for colonoscopy has renewed the interest for unsedated procedures. Alternative techniques, such as carbon dioxide insufflation and warm-water infusion, have been advocated to improve patient tolerance for colonoscopy in comparison with air insufflation. The aim of this study was to evaluate the benefits of carbon dioxide insufflation and warm-water irrigation over air insufflation in unsedated patients. This study was a randomized, controlled trial. This study was conducted at a nonacademic single center. Consecutive outpatients agreeing to start colonoscopy without premedication were included. Patients were assigned to either carbon dioxide insufflation, warm-water irrigation, or air insufflation colonoscopy insertion phase. Sedation/analgesia were administered on patient request if significant pain or discomfort occurred. The primary outcome measured was the percentage of patients requiring sedation/analgesia. Pain and tolerance scores were assessed at discharge by using a 100-mm visual analog scale. Three hundred forty-one subjects (115 in the carbon dioxide, 113 in the warm-water, and 113 in the air group) were enrolled. Intention-to-treat analysis showed that the proportion of patients requesting sedation/analgesia during colonoscopy was 15.5% in the carbon dioxide group, 13.2% in the warm-water group, and 25.6% in the air group (p = 0.04 carbon dioxide vs air; p = 0.03 warm water vs air). Median (interquartile range) scores for pain were 30 (10-50), 28 (15-50), and 46 (22-62) in the carbon dioxide, warm-water, and air groups (carbon dioxide vs air, p < 0.01; warm water vs air, p < 0.01); corresponding figures for tolerance were 20 (5-30), 19 (5-36), and 28 (10-50) (carbon dioxide vs air, p < 0.01; warm water vs air, p < 0.01). This investigation was limited because it was a single-center study and the endoscopists were not blinded to randomization. Carbon dioxide insufflation was associated with a decrease in the proportion of patients requesting on-demand sedation, improved patient tolerance, and decreased colonoscopy-related pain in comparison with air insufflation. The findings regarding warm-water irrigation confirmed the previously reported advantages, so that warm-water irrigation and carbon dioxide insufflation could represent competitive strategies for colonoscopy in unsedated patients.

A novel application of the water exchange method in the treatment of sigmoid volvulus: a report of two cases

Water immersion for colonoscopy was originally developed as an adjunct to air insufflation. It facilitated passage through the sigmoid colon and decreased cecal intubation time. From this technique evolved the water exchange method for screening and diagnostic colonoscopies. Water exchange uses cycles of warm water infusion and suction during insertion in lieu of air insufflation to avoid over-distension of the colon. In this report, we describe a novel application of the water exchange method in the effective and safe treatment of sigmoid volvulus in two patients. In both cases, the patients tolerated the procedure well and did not require sedation. controlled water exchange allowed for mucosal visualization without exacerbating the trapped air proximal to the volvulus, potentially decreasing the risk of perforation. Our findings suggest that the water exchange method is an effective and safe practice for endoscopic detorsion of acute, nonstrangulated sigmoid volvulus.

Warm water infusion during sedated colonoscopy does not decrease amount of sedation medication used

Water infusion versus air insufflation during colonoscope insertion has been suggested to reduce patient discomfort and decrease sedation medication requirements. Warm water is thought to further facilitate colonoscopy perhaps by decreasing colon spasm. To compare the utility of warm (35°-38°C) versus cool (20°-23°C) water infused during colonoscopic insertion by measuring patient sedation medication use and discomfort scores between the warm and cool water groups. Randomized, controlled, double-blinded study. Outpatient endoscopy unit at an academic medical center. A total of 175 adults. Elective outpatient sedated screening colonoscopies. Sedation medication used, pain scores, cecal intubation rate, endoscopy times, satisfaction scores, and patient willingness to repeat procedures. There was no significant difference in sedation medication requirement during colonoscopy with the use of warm or cool water (fentanyl 83.6 ± 29.0 μg vs 87.6 ± 39.6 μg; P = .45; midazolam 3.3 ± 1.2 mg vs 3.3 ± 1.3 mg; P = .91). There was no significant difference in patient pain scores or satisfaction scores. Cecal intubation rates (100%) were similar. There was no significant difference in cecal intubation times (6 minutes 40 seconds ± 4 minutes 9 seconds vs 7 minutes 49 seconds ± 4 minutes 0 seconds; P = .06) between the warm and cool water groups. All patients were willing to repeat the colonoscopy by using the same method in both groups. Limited generalizability to patients undergoing screening sedated colonoscopies with good to excellent bowel preparation. Water does not need to be warmed before infusion in patients undergoing sedated colonoscopies.

Warm water infusion colonoscopy: a review and meta-analysis

Warm water infusion instead of traditional air insufflation during the insertion phase of colonoscopy has been proposed to reduce pain and improve patient acceptance of the procedure. This systematic review aimed to compare warm water infusion with standard air insufflation according to findings from randomized controlled trials (RCTs). In a systematic review and meta-analysis of RCTs comparing warm water infusion with standard air insufflation, primary outcome measures were procedure-related (cecal intubation, time to cecal intubation, and adenoma detection rates) and patient-related (pain). Nine studies (1283 patients) were included. Warm water infusion, as sole modality for facilitating insertion, was associated with a fourfold higher risk of cecal intubation failure compared with air insufflation (risk ratio [RR] 4.01, confidence interval [CI] 1.17 to 13.78, P = 0.03), but this risk did not significantly differ between warm water infusion and air insufflation with the hybrid technique (i. e., brief use of air when difficulty, e. g. poor view, was encountered). Warm water infusion and air insufflation were associated with similar cecal intubation times (P = 0.62) and adenoma detection rates (P = 0.49), but with warm water infusion patients experienced significantly less pain (P < 0.00001) and a significantly lower proportion requested sedation and/or analgesia (RR 0.48, CI 0.35 to 0.66, P < 0.00001). Although failure of cecal intubation is more frequent with warm water infusion, technical modifications, i. e., short air insufflations, can abolish this. Warm water infusion is less painful than standard air insufflation, reduces the need for sedation/analgesia, and improves patient acceptance of colonoscopy, without additional adverse reactions.

Warm Water Infusion Colonoscopy: Review and Meta-Analysis

Background and study aims: Warm water infusion (WI) instead of traditional air insufflation (AI) during the insertion phase of colonoscopy has been proposed to reduce the pain and to improve patients' acceptance of the procedure. The aim of this systematic review was to compare WI against standard AI according to findings from randomized controlled trials (RCTs).

Interim report of a randomized cross-over study comparing clinical performance of novice trainee endoscopists using conventional air insufflation versus warm water infusion colonoscopy

The applicability of water method colonoscopy in trainee education is not known. To compare the water method vs. usual air method in teaching novice trainee colonoscopy. An IRB approved prospective randomized cross-over study (NCT01482546) in a university setting with diverse patient population. Three first year GI fellows consented to participate in the study. Trainees were randomized to learn with either usual air method or the water method in performing colonoscopy with a dedicated endoscopy attending during their weekly outpatient endoscopy clinics for the initial six months of training and then cross-over to the other method for the remaining six months. Patients undergoing screening, surveillance or diagnostic colonoscopy. The interim data revealed no significant difference in age, gender, and body mass index (BMI). Trainees rated the water method colonoscopy as significantly easier to learn compared to the air method (p=0.007). The interim data demonstrate positive effects of using the water method in training novice endoscopists who reported a significant ease of learning colonoscopy using this method. Training programs could consider joining us in evaluating the use of warm water infusion in colonoscopy education.

Tu1689 Warm Water Infusion Colonoscopy: A Review and Meta-Analysis

Warm water infusion (WI) through the working channel of the colonoscope during the insertion phase instead of air insufflation (AI) has been proposed to reduce the pain, thereby improving patients acceptance of the procedure and to enable unsedated colonoscopy. The aim of this study was to compare WI against standard AI based on findings from randomized controlled trials (RCTs).

Su1299 Interim Report of a Randomized Cross-Over Study Comparing Clinical Performance of Novice Trainee Endoscopists Using Conventional Air Insufflation Versus Warm Water Infusion Colonoscopy

Su1299 Interim Report of a Randomized Cross-Over Study Comparing Clinical Performance of Novice Trainee Endoscopists Using Conventional Air Insufflation Versus Warm Water Infusion Colonoscopy

The water method significantly enhances patient-centered outcomes in sedated and unsedated colonoscopy

Failure of cecal intubation when using air insufflation during scheduled unsedated colonoscopy in veterans prompted a literature search for a less uncomfortable approach. Water-related maneuvers as "adjuncts" to air insufflation were identified as effective in minimizing discomfort, although medication requirement was not reduced and willingness to repeat unsedated colonoscopy was not addressed. These adjunct maneuvers were combined with turning the air pump off to avoid colon elongation during insertion. Warm water infusion in lieu of air insufflation was evaluated in observational studies. Subsequent refinements evolved into the water method - a combination of air exclusion by aspiration of residual air to minimize angulations at flexures and a dynamic process of water exchange to remove feces in order to clear the view and aid insertion. In subsequent randomized controlled trials, the water method significantly reduced medication requirement, increased the proportion of patients in whom complete unsedated colonoscopy could be achieved, reduced patient recovery time burdens (sedation on demand), decreased abdominal discomfort during and after colonoscopy, enhanced cecal intubation, and increased willingness to repeat the procedure (scheduled unsedated). Supervised education of trainees and self-learning by an experienced colonoscopist were feasible. Lessons learned in developing the water method for optimizing patient-centered outcomes are presented. These proof-of-principle observations merit further research assessment in diverse settings.

602 Carbon Dioxide Insufflation (CO2) and Warm Water Infusion (WWI) Versus Standard Air Insufflation (AI): Preliminary Results of a Randomized Controlled Trial in Unsedated Colonoscopy

Due to the increasing demand for colonoscopy in clinical practice, great interest has recently renewed for unsedated colonoscopy. Both Carbon dioxide Insufflation (CO2) and Warm Water Infusion (WWI) have been advocated to improve patient tolerance for colonoscopy as compared to standard Air Insufflation (AI). This study is aimed at evaluating the performance of the above techniques versus AI in unsedated patients.

Tu1407 Vital Signs and Serum Electrolyte Levels Are Well Preserved After Large Volume Water Exchange in the Colonic Lumen Used With the Water Method

The water method is superior to usual air insufflation for screening and surveillance colonoscopy. In RCT it reduces sedation medication requirement; attenuates discomfort and enhances cecal intubation in unsedated patients. The water method entails the use of warm water infusion in lieu of air insufflation combined with suction removal of residual air to minimize angulations throughout the colon and water exchange to remove feces to clear the luminal view to aid insertion of the colonoscope. Up to one to two liters of water are usually infused and removed during a 15 to 20 min interval of insertion.

The water method combined with chromoendoscopy enhances adenoma detection

BACKGROUND: The water method is easy-to-learn and improves colonoscopy outcomes. Dye-spray chromoendoscopy enhances ADR but has not been widely accepted for routine application in screening or surveillance colonoscopy. HYPOTHESIS: With dye added to the water used in the water method, ADR can be enhanced compared with the water or air method alone. OBJECTIVE: To compare ADR determined by the air method, water method alone, and water method with indigo carmine (0.008%) added. DESIGN: Review of prospectively collected data in a performance improvement program. SETTING: VA endoscopy unit. PATIENT: Screening or surveillance colonoscopy. METHODS: Patients (n=50/group) underwent colonoscopy with each of the three methods. Water method involved warm water infusion in lieu of air insufflation coupled with removal of residual air by suction and residual feces by water exchange. ADR and procedural data were collected prospectively to monitor performance. MAIN OUTCOME MEASUREMENTS: ADR. RESULTS: ADR in the air method, water method alone and water method with indigo carmine were 36%, 40% and 62%, respectively. Water method with indigo carmine produced significantly higher ADR than the air or water method alone (p<0.05). LIMITATIONS: Non-randomized data, single VA site, retrospective comparison. Absence of significant difference between air and water methods could be a type II error due to small number of patients CONCLUSIONS: The approach with indigo carmine added to the water used in the water method yielded significantly higher ADR than the water or the air method alone. The data suggest that a prospective RCT to compare the different methods is warranted.

Retrospective analysis showing the water method increased adenoma detection rate - a hypothesis generating observation

BACKGROUND: A water method developed to attenuate discomfort during colonoscopy enhanced cecal intubation in unsedated patients. Serendipitously a numerically increased adenoma detection rate (ADR) was noted. OBJECTIVE: To explore databases of sedated patients examined by the air and water methods to identify hypothesis-generating findings. DESIGN: Retrospective analysis. SETTING: VA endoscopy center. PATIENTS: creening colonoscopy. INTERVENTIONS: From 1/2000-6/2006 the air method was used - judicious air insufflation to permit visualization of the lumen to aid colonoscope insertion and water spray for washing mucosal surfaces. From 6/2006-11/2009 the water method was adopted - warm water infusion in lieu of air insufflation and suction removal of residual air to aid colonoscope insertion. During colonoscope withdrawal adequate air was insufflated to distend the colonic lumen for inspection, biopsy and polypectomy in a similar fashion in both periods. Main outcome measurements: ADR. RESULTS: The air (n=683) vs. water (n=495) method comparisons revealed significant differences in overall ADR 26.8% (183 of 683) vs. 34.9% (173 of 495) and ADR of adenomas >9 mm, 7.2% vs. 13.7%, respectively (both P<0.05, Fisher's exact test). LIMITATIONS: Non-randomized data susceptible to bias by unmeasured parameters unrelated to the methods. CONCLUSION: Confirmation of the serendipitous observation of an impact of the water method on ADR provides impetus to call for randomized controlled trials to test hypotheses related to the water method as an approach to improving adenoma detection. Because of recent concerns over missed lesions during colonoscopy, the provocative hypothesis-generating observations warrant presentation.

Is there a place for sedationless colonoscopy?

Usedated colonoscopy is routinely available in many parts of the world. In the US, only educated professionals appear to be knowledgeable enough to request the unsedated option. Colonoscopists have also been willing to perform unsedated colonoscopy when a patient presents without an escort after undergoing bowel purge preparation. While the actual side-effects of sedation are minimal, the escort requirement and time burden of sedation are barriers to the uptake of screening colonoscopy in the US. The recent trend of deep sedation with propofol for screening colonoscopy increases the efficiency of the colonoscopists at significant costs (e.g. anesthetist reimbursement). The options of as needed and on demand sedation permit patients to complete colonoscopy without sedation. The latter appears to be potentially less coercive. Nurses with experience in the unsedated options recognize the benefit of the quick turn-around of the examination room and shortened occupancy of the recovery area. Discharge planning can be optimized due to absence of amnesia. Patients completing unsedated colonoscopy have given their endorsement of the options. Pain and discomfort continue to limit the success rate of cecal intubation to about 80%. A recently described water method (warm water infusion in lieu of air insufflation combined with removal of all residual colonic air by suction and residual feces by water exchange) has the potential of decreasing procedural discomfort and enhancing cecal intubation in unsedated colonoscopy. The availability of the novel water method assures colonoscopists that high success rate of cecal intubation can be achieved in the unsedated patients.

Warm water infusion versus air insufflation for unsedated colonoscopy: a randomized, controlled trial

Uncontrolled data suggest that warm water infusion (WWI) instead of air insufflation (AI) during the insertion phase of unsedated colonoscopy improves patient tolerance and satisfaction. We tested the hypothesis that water could increase the proportion of patients able to complete unsedated colonoscopy and improve patient tolerance compared with the conventional procedure. Randomized, controlled trial. Single center, community hospital. Consecutive outpatients agreeing to start colonoscopy without premedication. Patients were randomly assigned to either WWI or AI insertion phase of colonoscopy. Sedation and/or analgesia were administered on patient request if significant pain or discomfort occurred. Percentage of patients requiring sedation/analgesia. Pain and tolerance scores were assessed at discharge by using a 100-mm visual analog scale. A total of 230 subjects (116 in the WWI group and 114 in the AI group) were enrolled. Intention-to-treat analysis showed that the proportion of patients requesting sedation/analgesia during the procedure (main outcome measurement) was 12.9% in the WWI group and 21.9% in AI group (P = .07). Cecal intubation rates were 94% in the WWI group and 95.6% in the AI group (P = .57). Median (interquartile range) scores for pain were 28 (12-44) and 39 (14-54) in WWI and AI groups, respectively (P = .05); corresponding figures for tolerance were 10 (3-18) and 14 (5-42), respectively (P = .01). The adenoma detection rates were 25% and 40.1% for the WWI and AI groups, respectively (P = .013). Single-center study, endoscopists not blinded to randomization. WWI instead of AI is not associated with a statistically significant decrease in the number of patients requiring on-demand sedation, although it significantly improves the overall patient tolerance of colonoscopy. The finding of a lower adenoma detection rate in the WWI group calls for further evaluations. ( NCT00905554).