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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(03): E394-E401
DOI: 10.1055/a-2251-3478
DOI: 10.1055/a-2251-3478
Original article
Water exchange technique improves colonoscopy in patients with spinal cord injury: Results of a matched cohort study
Abstract
Background and study aims Colonoscopies in patients with spinal cord injury (SCI) frequently remain incomplete. This study aimed to evaluate the feasibility and impact of water exchange colonoscopy (WE) in patients with SCI.
Patients and methods Three matched groups, each of 31 patients (WE in SCI patients [WE-SCI]) and in the general population (WE-GP), carbon dioxide-based colonoscopy in SCI patients (CO2-SCI)) were analyzed retrospectively.
Results Intubation of the cecum and the terminal ileum was achieved in every case in both WE groups. The intubations among the CO2-SCI patients succeeded in 29 cases (93.5 %, ns) and 20 cases (64.5 %, P<0.001), respectively. The cecal insertion time (23:17 ± 10:17 min vs. 22:12 ± 16:48 min) and bowel preparation during cecal insertion did not differ between WE-SCI groups. Insertion in the general population was faster (13:38 ± 07:00 min, P<.001) and cleanliness was better. Both WE-SCI groups showed significantly better cleansing results during drawback; the improvement in cleanliness was highest in the WE-SCI (based on the five-step scale 1.4 ± 0.8 vs. 0.8 ± 0.8, P = 0.001).
Conclusions The WE in SCI patients is feasible and safe and has the potential to improve the quality of colonoscopies substantially.
Publication History
Received: 12 July 2023
Accepted after revision: 05 December 2023
Accepted Manuscript online:
22 January 2024
Article published online:
18 March 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
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References
- 1 Vallès M, Vidal J, Clavé P. et al. Bowel dysfunction in patients with motor complete spinal cord injury: clinical, neurological, and pathophysiological associations. Am J Gastroenterol 2006; 101: 2290-2299
- 2 Awad RA. Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease. World J Gastroenterol 2011; 17: 5035-5048 DOI: 10.3748/wjg.v17.i46.5035. (PMID: 22171138)
- 3 Blanco Belver A, Aach M, Schmiegel W. et al. Similar adenoma detection r in colonoscopic procedures of patients with spinal cord injury compared to controls. Dig Dis Sci 2020; 65: 1197-1205
- 4 Ancha HR, Spungen AM, Bauman WA. et al. Clinical trial: the efficacy and safety of routine bowel cleansing agents for elective colonoscopy in persons with spinal cord injury – a randomized prospective single-blind study. Aliment Pharmacol Ther 2009; 30: 1110-1107
- 5 Korsten MA, Spungen AM, Radulovic M. et al. Neostigmine administered with MoviPrep improves bowel preparation for elective colonoscopy in patients with spinal cord injury: a randomized study. J Clin Gastroenterol 2015; 49: 751-756
- 6 Morris BP, Kucchal T, Burgess AN. Colonoscopy after spinal cord injury: a case-control study. Spinal Cord 2015; 53: 32-35 DOI: 10.1038/sc.2014.164. (PMID: 25366532)
- 7 Hayman AV, Guihan M, Fisher MJ. et al. Colonoscopy is high yield in spinal cord injury. J Spinal Cord Med 2013; 36: 436-442 DOI: 10.1179/2045772313Y.0000000091. (PMID: 23941791)
- 8 Cadoni S, Ishaq S. How to perform water exchange colonoscopy, with tips and tricks. VideoGIE 2019; 23: 355-357 DOI: 10.1016/j.vgie.2019.03.021. (PMID: 31388609)
- 9 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
- 10 Zhang Z, Wu Y, Sun G. et al. Bayesian network meta-analysis: efficacy of air insufflation, CO2 insufflation, water exchange, and water immersion in colonoscopy. Dig Endosc 2018; 30: 321-331 DOI: 10.1111/den.13012. (PMID: 29334136)
- 11 Cadoni S, Falt P, Gallittu P. et al. Water exchange is the least painful colonoscope insertion technique and increases completion of unsedated colonoscopy. Clin Gastroenterol Hepatol 2015; 13: 1972-1980 DOI: 10.1016/j.cgh.2015.04.178. (PMID: 25956838)
- 12 Luo H, Zhang L, Liu X. et al. Water exchange enhanced cecal intubation in potentially difficult colonoscopy. Unsedated patients with prior abdominal or pelvic surgery: a prospective, randomized, controlled trial. Gastrointest Endosc 2013; 77: 767-773 DOI: 10.1016/j.gie.2012.12.007. (PMID: 23394837)
- 13 Cadoni S, Hassan C, Frazzoni L. et al. Impact of water exchange colonoscopy on endoscopy room efficiency: a systematic review and meta-analysis. Gastrointest Endosc 2019; 89: 159-167 DOI: 10.1016/j.gie.2018.07.020. (PMID: 30048649)
- 14 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 DOI: 10.1055/s-0043-101229. (PMID: 28282689)
- 15 Hsieh YH, Tseng CW, Hu CT. et al. Prospective multicenter randomized controlled trial comparing adenoma detection rate in colonoscopy using water exchange, water immersion, and air insufflation. Gastrointest Endosc 2017; 86: 192-201 DOI: 10.1016/j.gie.2016.12.005. (PMID: 27988288)
- 16 Jia H, Pan Y, Guo X. et al. Water exchange method significantly improves adenoma detection rate: a multicenter, randomized controlled trial. Am J Gastroenterol 2017; 112: 568-576
- 17 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
- 18 Hafner S, Zolk K, Radaelli F. et al. Water infusion versus air insufflation for colonoscopy. Cochrane Database Syst Rev 2015; 5: CD009863 DOI: 10.1002/14651858.CD009863.pub2. (PMID: 26011829)
- 19 Cheng CL, Kuo YL, Hsieh YH. et al. Comparison of right colon adenoma miss rates between water exchange and carbon dioxide insufflation: a prospective randomized controlled trial. J Clin Gastroenterol 2021; 55: 869-875
- 20 Asai S, Fujimoto N, Tanoue K. et al. Water immersion colonoscopy facilitates straight passage of the colonoscope through the sigmoid colon without loop formation: randomized controlled trial. Dig Endosc 2015; 27: 345-353
- 21 Vemulapalli KC, Rex DK. Water immersion simplifies cecal intubation in patients with redundant colons and previous incomplete colonoscopies. Gastrointest Endosc 2012; 76: 812-817 DOI: 10.1016/j.gie.2012.05.033. (PMID: 22901988)
- 22 Pohl J, Messer I, Behrens A. et al. Water infusion for cecal intubation increases patient tolerance, but does not improve intubation of unsedated colonoscopies. Clin Gastroenterol Hepatol 2011; 9: 1039-1043
- 23 Kirshblum SC, Burns SP, Biering-Sorensen F. et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med 2011; 34: 535-546 DOI: 10.1179/204577211X13207446293695. (PMID: 22330108)
- 24 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383 DOI: 10.1016/0021-9681(87)90171-8. (PMID: 3558716)
- 25 Lichtenstein DR, Jagannath S, Baron TH. et al. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2008; 68: 815-826 DOI: 10.1016/j.gie.2008.06.002. (PMID: 18656591)
- 26 Dumonceau JM, Riphaus A, Schreiber F. et al. Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline – Updated June 2015. Endoscopy 2015; 47: 1175-1189 DOI: 10.1055/s-0034-1393414. (PMID: 26561915)
- 27 Riphaus A, Wehrmann T, Hausmann J. et al. Update S3-guideline: “Sedation for gastrointestinal endoscopy” 2014 (AWMF-register-no. 021/014). Z Gastroenterol 2016; 54: 58-95
- 28 Halphen M, Heresbach D, Gruss HJ. et al. Validation of the Harefield Cleansing Scale: a tool for the evaluation of bowel cleansing quality in both research and clinical practice. Gastrointest Endosc 2013; 78: 121-131
- 29 World Health Organization. Classification of Tumours. Lyon: IARC Press; 2019. DOI: 10.1007/s12105-014-0533-9 (PMID: 24595422)
- 30 Tutein Nolthenius CJ, Boellaard TN, Haan MC de. et al. Evolution of screen-detected small (6–9 mm) polyps after a 3-year surveillance interval: assessment of growth with CT colonography compared with histopathology. Am J Gastroenterol 2015; 110: 1682-1690
- 31 Winawer SJ, Zauber AG. The advanced adenoma as the primary target of screening. Gastrointest Endosc Clin N Am 2002; 12: 1-9 DOI: 10.1038/ajg.2015.340. (PMID: 11916153)
- 32 Bibbins-Domingo K, Grossman DC. et al. US Preventive Services Task Force, Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 2016; 315: 2564-2575 DOI: 10.1001/jama.2016.5989. (PMID: 27304597)
- 33 German Guideline Program in Oncology (German Cancer Society, German Cancer Aid, AWMF): S3-Guideline Colorectal Cancer, long version 2.1, 2019, AWMF registration number: 021–007OL. http://www.leitlinienprogramm-onkologie.de/leitlinien/kolorektales-karzinom/
- 34 Burke CA, Church JM. Enhancing the quality of colonoscopy: the importance of bowel purgatives. Gastrointest Endosc 2007; 66: 565-573 DOI: 10.1016/j.gie.2007.03.1084. (PMID: 17725947)
- 35 Bick BL, Vemulapalli KC, Rex DK. Regional center for complex colonoscopy: yield of neoplasia in patients with prior incomplete colonoscopy. Gastrointest Endosc 2016; 83: 1239-1244 DOI: 10.1016/j.gie.2015.10.053. (PMID: 26584785)