Comparison of air colonoscopy and water colonoscopy techniques according to procedure performance criteria

Water colonoscopy is a technique that uses water to obtain luminal view during insertion of the colonoscope through to the ceacum. Some water related colonoscopy techniques use purely water and some that use of air in adjunct to water are also described. It has been shown in previous studies that water colonoscopy techniques improved ceacum insertion rates and times, and also reduced the procedure related patient pain and discomfort. In this study, we compared water and air colonoscopy techniques that used in our endoscopy clinic.Analyses were held within the procedure data that obtained from adult patients in whom colonoscopy was performed for the first time. Ninety-nine air and 101 water colonoscopy procedure data were analysed.According to procedure performance criteria: Ceacum insertion rates were found 98.9% for air and 99% for water colonoscopy. Shorter ceacum insertion times were found in air colonoscopy (air 5.3±2.6, water 7.2±2.9mn, p=0.001). More proportion of patients in water colonoscopy were diagnosed with colorectal polyp (water %19.8, air %11.1, p=0.132). Number of polyps were higher in water group, but was found statistically insignificant (water 1.45±0.75, air 1.27±0.46, p=0,488). No difference was found between pain, tolerability, and willingness to repeat the procedure in patient assessment scores. Pain score was found similar in endoscopist?s assessment. More proportion of patient in water colonoscopy group finished the procedure without sedation (air %26.4, water %43.7, p=0.142). From the endoscopist?s point of view, in women, water colonoscopy was found more painful (air 1.44±0.58, water 1.71±0.67, p=0.042), and difficult (air 1.31±0.55, water 1.69±0.74, p=0.006). Last 51 water colonoscopy cases were compared with the first 50, and significant improvements were found in performance criteria.In conclusion, water colonoscopy technique is as successful as air colonoscopy technique by means of procedure performance criteria. In situations that sedation is not preferred by the patient or contraindicated due to a medical condition, water colonoscopy can be preferred to air colonoscopy. As water colonoscopy technique detects polyps more than air technique, screening colonoscopy with water infusion technique is promising for the future. There is a need for further evaluation with prospective, randomized, controlled studies that uses the same water infusion technique.