Background and Aims

Water-aided colonoscopy techniques, such as water immersion (WI) and water exchange (WE), have shown different results regarding adenoma detection rate (ADR). We determined the impact of WI and WE on ADR and other procedural outcomes versus gas (air, AI; CO₂) insufflation colonoscopy.

Methods

A systematic search of multiple databases for randomized controlled trials comparing WI and/or WE with AI and/or CO₂ and reporting ADR was conducted. A network meta-analysis with mixed comparisons was performed. Primary outcome was ADR (overall, in the right side of the colon and by colonoscopy indication).

Results

Seventeen randomized controlled trials (10,350 patients) were included. WE showed a significantly higher overall ADR versus WI (odds ratio [OR], 1.31; 95% credible interval [CrI], 1.12-1.55) versus AI (OR, 1.40; CrI, 1.22-1.62) versus CO₂ (OR, 1.48; 95% CrI, 1.15-1.86). WE achieved the highest ADR also in the right side of the colon and in colorectal cancer screening cases (both significant vs AI and WI) as well as in patients taking a split-dose preparation (significant vs all the other techniques). The Boston Bowel Preparation Scale cleanliness score (vs AI and WI) was significantly higher for WE. Both WI and WE showed increased proportion of unsedated examinations and decreased real-time insertion pain, with WE being the least-painful insertion technique. Withdrawal time was comparable across techniques, but WE showed the longest insertion time (3-5 additional minutes).

Conclusions

WE significantly increases overall ADR, ADR in screening cases, and in the right side of the colon; it also improves colon cleanliness but requires a longer insertion time.

中文翻译：

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换水结肠镜检查可提高腺瘤的检出率：对随机对照研究进行网络荟萃分析的系统评价

背景和目标

水浸结肠镜检查技术，例如水浸（WI）和水交换（WE），已显示出关于腺瘤检出率（ADR）的不同结果。我们确定了WI和WE对ADR和其他程序结果与气体（空气，AI，CO ₂）吹入结肠镜检查的影响。

方法

对多个数据库进行系统搜索，以比较WI和/或WE与AI和/或CO ₂并报告ADR的随机对照试验。进行了带有混合比较的网络荟萃分析。主要结局为ADR（总体而言，在结肠的右侧，并通过结肠镜检查显示）。

结果

包括十七项随机对照试验（10,350例患者）。WE显示，ADR与WI的整体ADR明显高于AI（优势比[OR]为1.31； 95％可信区间[CrI]为1.12-1.55）与AI相比（OR为1.40； CrI为1.22-1.62）与CO ₂相比（OR，1.48； 95％CrI，1.15-1.86）。在结肠的右侧和结肠直肠癌筛查病例（显着性与AI和WI相比）以及采用分剂量制剂的患者（显着性与所有其他技术）中，我们也达到了最高的ADR。WE的Boston Bowel准备量表清洁度得分（相对于AI和WI）明显更高。WI和WE均显示出未镇静检查的比例增加，实时插入疼痛减少，WE是痛苦最小的插入技术。撤回时间在所有技术上均相当，但WE显示出最长的插入时间（额外3-5分钟）。

结论

我们显着提高了总体ADR，在筛查病例和结肠右侧增加了ADR；它还可以改善结肠的清洁度，但需要更长的插入时间。