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Water exchange enhances colon cleanliness, adenoma detection in propofol-sedated patients

18 Jul 2019

Colonoscopy in patients under propofol sedation may be enhanced with the water exchange (WE) method by significantly improving colon cleanliness and overall adenoma detection rate (ADR), suggests a recent study.

“Colonoscopists with patients under propofol sedation might consider evaluating WE method for performance improvement,” the investigators said.

This posthoc multiple logistic regression analyses used pooled data from two randomized controlled trials to determine the factors associated with adenoma detection in propofol-sedated patients. A total of 510 participants were randomly assigned to either air insufflation (AI) or WE.

Both groups had similar baseline characteristics. In multiple logistic regression analyses, the following factors significantly and independently correlated with higher ADR: age, indications (screening vs diagnostic), withdrawal time and WE.

There were fewer patients in the WE arm who had inadequate Boston Bowel Preparation Scale (BBPS) score of <6. Regardless of a significantly shorter inspection time, WE led to significantly higher overall ADR compared with AI, particularly in those with adequate BBPS of ≥6.

Furthermore, WE had a significantly higher right colon ADR (17.5 percent vs 10.5 percent), flat ADR (32.3 percent vs 19.4 percent), combined advanced and sessile serrated ADR (13.1 percent vs 7.4 percent) than AI.

Low ADR is believed to increase the risk of interval cancer and related deaths, according to the investigators. The WE method vs Ai colonoscopy significantly lessens insertion pain and improves ADR in unsedated patients.

“Deep sedation with propofol has been increasingly used in colonoscopy,” they noted. “One report suggested that WE significantly increased ADR in propofol-sedated patients, but the factors associated with adenoma detection were not analysed.”

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