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The revival of unsedated colonoscopy through water infusion

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Introduction : Unsedated colonoscopy using water infusion has been performed in a US veterans population, showing feasibility and even enhanced adenoma detection rate (Leung et al, J Interv Gastroenterol, 2011, 1, 8-13). Avoiding sedation or general anesthesia theoretically will avoid sedation related complications, could be time- and cost-saving, could improve patient satisfaction and reduce waiting lists for colonoscopy. Aim : To study the feasibility of unsedated colonoscopy by means of water infusion in a tertiary hospital setting. The primary endpoint of this trial is reaching the cecum without need for sedation. Methods : The water infusion technique for colonoscopy consists of using water at body temperature at insertion of the endoscope, instead of air insufflation. It is combined with removal of all residual colonic air by suction and residual feces by water exchange. Once the cecum is reached, air insufflation is used during withdrawal for mucosal inspection. All patients start the endoscopy unsedated but sedation and analgesia are administered if needed or asked for (midazolam 2,5 mg / pethidine 50 mg). When progression with water fails, switch to air insufflation is made. Pain scores are registred on a VAS (0=no pain, 10=maximal pain). Patient satisfaction and willing to repeat the procedure are also scored on a VAS (respectively: 0=very low, 10=high/ 0=not willing to repeat, 10=willing). Results : 38 patients (18F, 20M) with a mean age of 57 ± 11 yrs are included. Indications for colonoscopy are: cancer screening 24%, polyp surveillance 18%, diagnostic 58%. The primary endpoint, unsedated succesful cecal intubation, is reached in 27 patients (71,2%). The global cecal intubation rate is 94,7% (n=36). Mean insertion time was 14 ± 6 min. Mean length of the colonoscope at the cecum was 82 ± 10 cm. Mean volume of water infused upon arrival to the cecum is 332 ± 172 ml. In 11 patients (28,9%) temporary switch to air insufflation during insertion is needed (6 at the hepatic flexure, 5 in the sigmoid). Men reach the endpoint more readily than women (85% vs. 55,6%, p = 0,046). Age doesn’t make a difference (p = 0,62). Maximum mean pain score during insertion is 3,1 ± 2,7; pain at time of discharge is 1,5 ± 2,2. Patient satisfaction is 9,2 ± 1,2, willingness to repeat 9,7 ± 0,7. Mean withdrawal time is 8,8 + 4,6 min and the adenoma detection rate is 21%. Conclusions : Water-infused colonoscopy is a promising and simple technique to perform complete unsedated colonoscopy. This method may open perspectives for a new era in colonoscopy with high patient satisfaction and lower costs.

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Chicago
STRUBBE, BEATRIJS, Sam Beeckman, Martine De Vos, and Danny De Looze. 2012. “The Revival of Unsedated Colonoscopy Through Water Infusion.” In Acta Gastro-enterologica Belgica. Vol. 75.
APA
STRUBBE, B., Beeckman, S., De Vos, M., & De Looze, D. (2012). The revival of unsedated colonoscopy through water infusion. ACTA GASTRO-ENTEROLOGICA BELGICA (Vol. 75). Presented at the 24th Belgian Week of Gastroenterology.
Vancouver
1.
STRUBBE B, Beeckman S, De Vos M, De Looze D. The revival of unsedated colonoscopy through water infusion. ACTA GASTRO-ENTEROLOGICA BELGICA. 2012.
MLA
STRUBBE, BEATRIJS, Sam Beeckman, Martine De Vos, et al. “The Revival of Unsedated Colonoscopy Through Water Infusion.” Acta Gastro-enterologica Belgica. Vol. 75. 2012. Print.
@inproceedings{3228844,
  abstract     = {Introduction : Unsedated colonoscopy using water infusion has been performed in a US veterans population, showing feasibility and even enhanced adenoma detection rate (Leung et al, J Interv Gastroenterol, 2011, 1, 8-13). Avoiding sedation or general anesthesia theoretically will avoid sedation related complications, could be time- and cost-saving, could improve patient satisfaction and reduce waiting lists for colonoscopy.
Aim : To study the feasibility of unsedated colonoscopy by means of water infusion in a tertiary hospital setting. The primary endpoint of this trial is reaching the cecum without need for sedation.
Methods : The water infusion technique for colonoscopy consists of using water at body temperature at insertion of the endoscope, instead of air insufflation. It is combined with removal of all residual colonic air by suction and residual feces by water exchange. Once the cecum is reached, air insufflation is used during withdrawal for mucosal inspection. All patients start the endoscopy unsedated but sedation and analgesia are administered if needed or asked for (midazolam 2,5 mg / pethidine 50 mg). When progression with water fails, switch to air insufflation is made. Pain scores are registred on a VAS (0=no pain, 10=maximal pain). Patient satisfaction and willing to repeat the procedure are also scored on a VAS (respectively: 0=very low, 10=high/ 0=not willing to repeat, 10=willing).
Results : 38 patients (18F, 20M) with a mean age of 57 ± 11 yrs are included. Indications for colonoscopy are: cancer screening 24%, polyp surveillance 18%, diagnostic 58%. The primary endpoint, unsedated succesful cecal intubation, is reached in 27 patients (71,2%). The global cecal intubation rate is 94,7% (n=36). Mean insertion time was 14 ± 6 min. Mean length of the colonoscope at the cecum was 82 ± 10 cm. Mean volume of water infused upon arrival to the cecum is 332 ± 172 ml. In 11 patients (28,9%) temporary switch to air insufflation during insertion is needed (6 at the hepatic flexure, 5 in the sigmoid). Men reach the endpoint more readily than women (85% vs. 55,6%, p = 0,046). Age doesn’t make a difference (p = 0,62). Maximum mean pain score during insertion is 3,1 ± 2,7; pain at time of discharge is 1,5 ± 2,2. Patient satisfaction is 9,2 ± 1,2, willingness to repeat 9,7 ± 0,7. Mean withdrawal time is 8,8 + 4,6 min and the adenoma detection rate is 21%.
Conclusions : Water-infused colonoscopy is a promising and simple technique to perform complete unsedated colonoscopy. This method may open perspectives for a new era in colonoscopy with high patient satisfaction and lower costs.},
  articleno    = {abstract 191},
  author       = {STRUBBE, BEATRIJS and Beeckman, Sam and De Vos, Martine and De Looze, Danny},
  booktitle    = {ACTA GASTRO-ENTEROLOGICA BELGICA},
  issn         = {0001-5644},
  language     = {eng},
  location     = {Oostende, Belgium},
  number       = {1},
  title        = {The revival of unsedated colonoscopy through water infusion},
  volume       = {75},
  year         = {2012},
}