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.
