Randomised trial of ‘hybrid’ water-assisted colonoscopy (modified water immersion) versus water exchange colonoscopy: WAVE study

IF 2.4 Q3 GASTROENTEROLOGY & HEPATOLOGY

Frontline Gastroenterology Pub Date : 2024-04-29 DOI:10.1136/flgastro-2023-102606

Ahmir Ahmad, Anna Buenaventura, Belma Motes, Ravi Misra, Ripple Man, Angad Dhillon, Paul Bassett, Kowshika Thiruvilangam, Brian P Saunders

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Abstract

Background and aims Colonoscopy practice has evolved with a trend towards water-assisted insertion. A recent national survey suggests a hybrid approach to colonic distension during insertion, with water used predominately to the splenic flexure and carbon dioxide (CO2) with water used thereafter to the caecum, is commonly used. This contrasts with the water exchange technique where no CO2 is used. This study aimed to evaluate whether a hybrid or water exchange technique allows more efficient colonoscopy. Methods This prospective, randomised controlled trial was conducted between March 2021 and June 2022. Participants were randomised 1:1 to hybrid or water exchange colonoscopy, performed by four experienced colonoscopists. The primary outcome was total procedure time with secondary outcomes of caecal intubation time, caecal intubation rate, polyp detection, loop formation, number of ancillary manoeuvres, sedation use and patient comfort. Results 256 patients were invited, and 246 were randomised to either hybrid or water exchange colonoscopy. 122 patients were included in each arm of the primary analysis. Total procedure time was greater in the water exchange group compared with hybrid (29 vs 25 min, p=0.009). Patient reposition episodes occurred more frequently in the water exchange group vs hybrid group (5.5 vs 5, p=0.003) and left colon Boston Bowel Preparation Scale (BBPS) score was improved. No difference was seen in all other outcomes. Conclusion A hybrid technique, compared with water exchange, enabled faster colonoscopy without adversely impacting sedation requirement, caecal intubation, overall bowel cleansing and patient comfort. This technique appears to maximise the advantages of both water and CO2 to enable more efficient colonoscopy. Trial registration number [NCT04710706][1]. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04710706&atom=%2Fflgastro%2Fearly%2F2024%2F04%2F29%2Fflgastro-2023-102606.atom

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混合 "水辅助结肠镜检查（改良水浸法）与水交换结肠镜检查的随机试验：WAVE 研究

背景和目的结肠镜检查的实践已朝着水辅助插入的趋势发展。最近的一项全国性调查表明，在插入过程中，通常采用混合方法进行结肠扩张，即主要在脾曲部位使用水，在盲肠部位使用二氧化碳 (CO2)。这与不使用二氧化碳的水交换技术形成鲜明对比。本研究旨在评估混合技术或水交换技术是否能提高结肠镜检查的效率。方法这项前瞻性随机对照试验于 2021 年 3 月至 2022 年 6 月期间进行。参与者按 1:1 的比例随机接受混合式或水交换式结肠镜检查，由四名经验丰富的结肠镜医师进行操作。主要结果是手术总时间，次要结果是盲肠插管时间、盲肠插管率、息肉检测、襻形成、辅助操作次数、镇静剂使用和患者舒适度。结果 256 名患者受邀参加，246 名患者被随机分配到混合式或水交换式结肠镜检查。在主要分析中，两组各纳入了 122 名患者。水交换组的总手术时间比混合组长（29 分钟对 25 分钟，P=0.009）。换水组与混合组相比，患者重新定位的频率更高（5.5 对 5，P=0.003），左结肠波士顿肠道准备量表（BBPS）评分有所提高。其他结果无差异。结论混合技术与换水技术相比，结肠镜检查速度更快，但不会对镇静要求、盲肠插管、整体肠道清洁和患者舒适度产生不利影响。该技术似乎最大限度地发挥了水和二氧化碳的优势，从而提高了结肠镜检查的效率。试验注册号[NCT04710706][1]。与该研究相关的所有数据均包含在文章中或作为补充信息上传。[1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04710706&atom=%2Fflgastro%2Fearly%2F2024%2F04%2F29%2Fflgastro-2023-102606.atom

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来源期刊

Frontline Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

4.70

自引率

11.50%

发文量

期刊介绍： Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.