Background and Aims

Separate randomized controlled trials (RCTs) showed water exchange (WE) colonoscopy outperformed other techniques in minimizing insertion pain and optimizing adenoma detection rate. Longer insertion time required for removal of infused water, residual air, and feces might have hampered its wider adoption. We evaluate the impact of WE compared with air or carbon dioxide insufflation (GAS) on room turnaround efficiency measured by cecal intubation, withdrawal, and total procedure times.

Methods

With a systematic search in PubMed, Embase, and Cochrane Library, we identified RCTs (published before March 18, 2018) that compared WE with GAS. We focused on parameters of turnaround efficiency and patient-centered outcomes.

Results

We analyzed 8371 subjects from 17 studies. Demographics and indications were comparable. Mean cecal intubation time (± standard deviation) was WE 12.5 ± 6.1 minutes versus GAS 11.1 ± 7.0 minutes, with a mean difference of 1.4 ± 3.4 minutes. Six studies showed significant differences in insertion time, with mean cecal intubation times of 11.6 ± 5.1 minutes for WE versus 7.7 ± 5.2 minutes for GAS, with a mean difference of 3.9 ± 1.1 minutes. Mean withdrawal time was similar. Mean total procedure time was WE 26.0 ± 9.7 versus GAS 24.2 ± 9.6, with a mean difference of 1.8 ± 6.2 minutes. All mean procedure times were significantly different. Patient-centered outcomes revealed that patients examined with WE had significantly lower real-time insertion pain score, less need for sedation, and higher willingness to repeat the procedure.

Conclusions

Based on parameters of procedural time, the impact of WE colonoscopy on endoscopy room turnaround yields an increase in total procedure time of about 2 minutes and is associated with significant improvement in specific patient-centered outcomes.

中文翻译：

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换水结肠镜对内镜室效率的影响：系统评价和荟萃分析

背景和目标

单独的随机对照试验（RCT）显示，水交换（WE）结肠镜检查在最小化插入疼痛和优化腺瘤检出率方面优于其他技术。去除注入的水，残留空气和粪便所需的较长插入时间可能会妨碍其广泛采用。我们评估了WE与空气或二氧化碳吹注（GAS）相比对通过盲肠插管，戒断和总手术时间测得的房间周转效率的影响。

方法

通过在PubMed，Embase和Cochrane库中进行系统搜索，我们确定了将WE与GAS进行比较的RCT（于2018年3月18日之前发布）。我们专注于周转效率和以患者为中心的结果的参数。

结果

我们分析了17个研究中的8371个主题。人口统计学和适应症具有可比性。盲肠平均插管时间（±标准偏差）为WE 12.5±6.1分钟，而GAS为11.1±7.0分钟，平均差异为1.4±3.4分钟。六项研究显示插入时间有显着差异，WE的盲肠平均插管时间为11.6±5.1分钟，而GAS的盲肠插管平均时间为7.7±5.2分钟，平均差异为3.9±1.1分钟。平均撤药时间相似。平均总手术时间为WE 26.0±9.7，而GAS 24.2±9.6，平均差为1.8±6.2分钟。所有平均手术时间均显着不同。以患者为中心的结果表明，接受WE治疗的患者的实时插入疼痛评分显着降低，镇静需求更少，并且重复手术的意愿更高。

结论

根据手术时间的参数，WE结肠镜检查对内窥镜检查室周转的影响使总手术时间增加了约2分钟，并且与特定以患者为中心的结果显着改善有关。