Does Water Exchange Improve Adenoma Detection?

Water immersion (WI), or infusion of water during colonoscope insertion, is well known to reduce pain and to facilitate cecal intubation in patients with anatomically difficult colons. Unlike WI, water exchange (WE), involves simultaneous suctioning of dirty water during insertion, plus suctioning of residual air pockets.

In a multicenter, randomized, controlled trial, investigators compared adenoma detection rates (ADRs) among 1224 patients undergoing colonoscopy with air insufflation (AI), WI, or WE after split-dose bowel preparation. Insertion and withdrawal were performed by different colonoscopists (among 11 participating). The withdrawing endoscopist was blinded to the insertion method.

Cecal intubation time with WE was 9 minutes versus…