Gastrointestinal Endoscopy
Volume 69, Issue 3, Part 1 , Pages 546-550, March 2009

Impact of a novel water method on scheduled unsedated colonoscopy in U.S. veterans

Current affiliations: Department of Medicine, Division of Gastroenterology (F.W.L., H.S.A., P.H.G., G.J.), Research and Medical Services, Sepulveda Ambulatory Care Center, VAGLAHS, North Hills, Department of Medicine, Division of Gastroenterology (F.W.L., H.S.A., P.H.G.), Division of Gastroenterology (G.J.), David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Department of Medicine, Division of Gastroenterology (J.W.L.), Sacramento Veterans Affairs Medical Center, Veterans Affairs Northern California Healthcare System, Mather, Department of Medicine, Division of Gastroenterology (J.W.L.), University of California Davis Medical Center, Sacramento, California, USA

Received 30 June 2008; accepted 7 August 2008.

North Hills, California, USA

Background

Intermittent warm-water infusion in lieu of air insufflation permitted 52% of patients who accepted sedation on demand to complete colonoscopy without sedation.

Objective

To test the hypothesis that the water method enhances cecal intubation and increases the proportion of patients who report willingness to repeat a scheduled unsedated colonoscopy.

Design

Observational study.

Patients

Two consecutive groups of veterans.

Interventions

From June 2005 to May 2006, the usual air insufflation method was used to aid colonoscope insertion. From June 2006 to October 2007, the water method was used.

Main Outcome Measurements

Cecal intubation; report of willingness to repeat unsedated colonoscopy.

Results

Sixty-two and 63 veterans were examined by the air method and the water method, respectively. Intention-to-treat analysis revealed that the cecal intubation rate with the water method (97% [61/63]) was significantly higher than that with the air method (76% [47/62]). The proportion of patients who reported willingness to repeat unsedated colonoscopy was significantly higher with the water method (90% [57/63]) compared with the air method (69% [43/62]).

Limitations

Single site, nonrandomized, unblinded, small number of elderly male veterans.

Conclusion

The effects of the water method in the group for scheduled unsedated colonoscopy were sufficiently provocative to warrant calling for their confirmation by a randomized controlled trial.

Abbreviation: VAGLAHS, Veterans Affairs Greater Los Angeles Healthcare System

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 DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This study was supported in part by Veterans Affairs Clinical Merit Medical Research Funds and the American Society for Gastrointestinal Endoscopy Career Development Award (FWL 1985).

 Presented at Digestive Disease Week 2008, May 17-22, 2008, San Diego, California (Gastrointest Endosc 2008;67:AB281).

 If you want to chat with an author of this article, you may contact him at felix.leung@med.va.gov.

 See CME section; p. 525.

PII: S0016-5107(08)02426-7

doi:10.1016/j.gie.2008.08.014

Gastrointestinal Endoscopy
Volume 69, Issue 3, Part 1 , Pages 546-550, March 2009

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