Endoscopy 2020; 52(12): 1118-1121
DOI: 10.1055/a-1182-5211
Innovations and brief communications

Room temperature water infusion during colonoscopy insertion induces rectosigmoid colon mucus production

Ahmed El Rahyel
1   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
,
Connor D. McWhinney
1   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
,
Nasim Parsa
2   Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, Missouri, USA
,
Rachel E. Lahr
1   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
,
Krishna C. Vemulapalli
1   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
,
Douglas K. Rex
1   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
› Author Affiliations

Abstract

Background Water filling during colonoscopy improves several colonoscopy outcomes. We evaluated an anecdotal observation that room temperature water filling during colonoscope insertion results in mucus production in the left colon, which may impair mucosal visualization during withdrawal.

Methods We performed 55 colonoscopies with either water or saline filling during insertion, and video recorded the examinations. Three blinded observers scored the amount of mucus visible on the video recordings.

Results 29 patients had water filling and 26 patients had saline filling during insertion. Demographic features, procedure indications, volume of infused fluid, and insertion time to the cecum were similar in the two groups. All three blinded observers rated the mucus as greater after water filling than after saline (median 3 out of 5 vs. 1 out of 5; P < 0.001), with a kappa value for interobserver agreement of 0.364 (P < 0.001).

Conclusion Room temperature water filling is associated with mucus production by the rectosigmoid colon, requiring additional cleansing during withdrawal.

Tables 1s, 2s



Publication History

Received: 13 December 2019

Accepted: 20 May 2020

Accepted Manuscript online:
20 May 2020

Article published online:
15 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Hsieh YH, Koo M, Leung FW. A patient-blinded randomized, controlled trial comparing air insufflation, water immersion, and water exchange during minimally sedated colonoscopy. Am J Gastroenterol 2014; 109: 1390-1400
  • 2 Leung CW, Kaltenbach T, Soetikno R. et al. Water immersion versus standard colonoscopy insertion technique: randomized trial shows promise for minimal sedation. Endoscopy 2010; 42: 557-563
  • 3 Vemulapalli KC, Rex DK. Water immersion simplifies cecal intubation in patients with redundant colons and previous incomplete colonoscopies. Gastrointest Endosc 2012; 76: 812-817
  • 4 Fuccio L, Frazzoni L, Hassan C. et al. Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies. Gastrointest Endosc 2018; 88: 589-597 e511
  • 5 Cadoni S, Falt P, Rondonotti E. et al. Water exchange for screening colonoscopy increases adenoma detection rate: a multicenter, double-blinded, randomized controlled trial. Endoscopy 2017; 49: 456-467
  • 6 Binmoeller KF. Underwater EMR without submucosal injection: Is less more?. Gastrointest Endosc 2019; 89: 1117-1119
  • 7 Yamashina T, Uedo N, Akasaka T. et al. Comparison of underwater vs conventional endoscopic mucosal resection of intermediate-size colorectal polyps. Gastroenterology 2019; 157: 451-461 e452
  • 8 Spadaccini M, Fuccio L, Lamonaca L. et al. Underwater EMR for colorectal lesions: a systematic review with meta-analysis (with video). Gastrointest Endosc 2019; 89: 1109-1116 e1104
  • 9 Yen AW, Leung JW, Wilson MD. et al. Underwater versus conventional endoscopic resection of nondiminutive nonpedunculated colorectal lesions: a prospective randomized controlled trial (with video). Gastrointest Endosc 2020; 91: 643-654 e642
  • 10 Kim HG, Thosani N, Banerjee S. et al. Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps (with video). Gastrointest Endosc 2014; 80: 1094-1102
  • 11 Rex DK. Water filling and carbon dioxide insufflation: tools for every colonoscopist. Clinical Gastroenterol Hepatol 2015; 13: 1981-1983
  • 12 Anderson JC, Kahi CJ, Sullivan A. et al. Comparing adenoma and polyp miss rates for total underwater colonoscopy versus standard CO2: a randomized controlled trial using a tandem colonoscopy approach. Gastrointest Endosc 2019; 89: 591-598