Water exchange method for colonoscopy: learning curve of an experienced colonoscopist in a U.S. community practice setting.

Abstract

Background: Water exchange colonoscopy has been reported to reduce examination discomfort and to provide salvage cleansing in unsedated or minimally sedated patients. The prolonged insertion time and perceived difficulty of insertion associated with water exchange have been cited as a barrier to its widespread use.

Aim: To assess the feasibility of learning and using the water exchange method of colonoscopy in a U.S. community practice setting.

Setting: Quality improvement program in nonacademic community endoscopy centers.

Subjects: Patients undergoing sedated diagnostic, surveillance, or screening colonoscopy.

Methods: After direct coaching by a knowledgeable trainer, an experienced colonoscopist initiated colonoscopy using the water method. Whenever >5 min elapsed without advancing the colonoscope, conversion to air insufflation was made to ensure timely completion of the examination.

Primary outcome: Water Method Intention-to-treat (ITT) cecal intubation rate (CIR).

Results: Female patients had a significantly higher rate of past abdominal surgery and a significantly lower ITTCIR. The ITTCIR showed a progressive increase over time in both males and females to 85-90%. Mean insertion time was maintained at 9 to 10 min. The overall CIR was 99%.

Conclusion: Use of water exchange did not preclude cecal intubation upon conversion to usual air insufflation in sedated patients examined by an experienced colonoscopist. With practice ITTCIR increased over time in both male and female patients. Larger volumes of water exchanged were associated with higher ITTCIR and better quality scores of bowel preparation. The data suggest that learning water exchange by a busy colonoscopist in a community practice setting is feasible and outcomes conform to accepted quality standards.