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Meta-Analysis
. 2022 Sep;37(9):1785-1791.
doi: 10.1111/jgh.15896. Epub 2022 Jul 9.

A survey of colonoscopists with and without in-depth knowledge of water-aided colonoscopy

Felix W Leung  1 , Sergio Cadoni  2 , Malcolm Koo  3 , Andrew W Yen  4 , Keith Siau  5 , Yu-Hsi Hsieh  6 , Sauid Ishaq  7 , Chi-Liang Cheng  8 , Francisco C Ramirez  9 , Adrian W Bak  10 , William Karnes  11 , Putut Bayupurnama  12 , Joseph W Leung  4 , Piet C de Groen  13
Affiliations
Meta-Analysis

A survey of colonoscopists with and without in-depth knowledge of water-aided colonoscopy

Felix W Leung et al. J Gastroenterol Hepatol. 2022 Sep.

Abstract

Background and aim: Endoscopy featured water-aided colonoscopy (WAC) as novel in the Innovation Forum in 2011. Gastrointestinal Endoscopy published a modified Delphi consensus review (MDCR) that supports WAC for clinical practice in 2021. We tested the hypothesis that experience was an important predictor of WAC use, either as water immersion (WI), water exchange (WE), or a combination of WI and WE.

Methods: A questionnaire was sent by email to the MDCR authors with an in-depth knowledge of WAC. They responded and also invited colleagues and trainees without in-depth knowledge to respond. Logistic regression analysis was used with the reasons for WAC use treated as the primary outcome. Reports related to WAC post MDCR were identified.

Results: Of 100 respondents, > 80% indicated willingness to adopt and modify practice to accommodate WAC. Higher adenoma detection rate (ADR) incentivized WE use. Procedure time slots ≤ 30 and > 30 min significantly predicted WI and WE use, respectively. Co-authors of the MDCR were significantly more likely to perform WAC (odds ratio [OR] = 7.5, P = 0.037). Unfamiliarity with (OR = 0.11, P = 0.02) and absence of good experience (OR = 0.019, P = 0.002) were associated with colonoscopists less likely to perform WAC. Reports related to WAC post MDCR revealed overall and right colon WE outcomes continued to improve. Network meta-analyses showed that WE was superior to Cap and Endocuff. On-demand sedation with WE shortened nursing recovery time.

Conclusions: An important predictor of WAC use was experience. Superior outcomes continued to be reported with WE.

Keywords: survey; water exchange; water immersion; water-aided colonoscopy.

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References

    1. Leung FW, Leung JW, Mann SK, Friedland S, Ramirez F. Innovation Forum - The water method significantly enhances patient-centered outcomes in sedated and unsedated colonoscopy. Endoscopy 2011; 43: 816-821.
    1. Cadoni S, Ishaq S, Hassan C et al. Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations. Gastrointest. Endosc. 2021; 93: 1411-1420.e18.
    1. Gupta DM, Boland RJ, Aron DC. The physician's experience of changing clinical practice: a struggle to unlearn. Implementation Sci. 2017; 12: 28.
    1. Cadoni S, Ishaq S, Hassan C et al. Covid-19 pandemic impact on colonoscopy service and suggestions for managing recovery. Endosc. Int. Open 2020; 08: E985-E989.
    1. Leung FW, Koo M, Jia H et al. Water exchange (WE) and quality improvement-enhanced advanced adenoma detection: A pooled data analysis of 6 randomized controlled trials. J. Clin. Gastroenterol. 2020; 54: 212-217.

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