Missed lesions are believed to be a major cause of interval cancers (IC). They occur more commonly in the right colon which is difficult to clean with an air filled lumen. 1% increase in ADR reduced IC by 3% and mortality from IC by 5%. Calls to improved ADR led to use of split-dose preparation (SDP) and new methods of colonoscopy. Water exchange (WE) improved bowel prep and ADR. Adding cap-assisted colonoscopy (CAC) to WE (CAWE) enhanced salvage cleaning during insertion and increased ADR on withdrawal in air filled lumen (GIE 2013;77:944). Pilot data indicated WE during withdrawal facilitated bowel cleansing. Combining CAC with WE during insertion and withdrawal as total water method (CATW) is an innovative approach. We present data to show CATW further improved bowel cleanliness, and enhanced right and proximal colon ADR compared with CAWE in screening colonoscopy.
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© 2017 Published by Elsevier Inc.