Trial reportThe American journal of gastroenterology2014
A patient-blinded randomized, controlled trial comparing air insufflation, water immersion, and water exchange during minimally sedated colonoscopy.
Trial report in The American journal of gastroenterology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 48 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Comparing Air Insufflation, Water Immersion and Water Exchange Methods During Minimal Sedated Colonoscopy, a Randomized, Controlled Trial
Prospective RCT of Water Exchange (WE) vs. WE Plus Cap-Assisted Colonoscopy
Abdominal Compression Administered Early by the Colonoscopist Shortened Insertion Time of Water Exchange Colonoscopy
Randomized Controlled Trial Comparing the Impact of Water Assisted Colonoscopy vs Air Insufflation on Resident Training
Prospective Randomized Controlled Trial (RCT)Comparing Clinical Outcomes Between Underwater Versus Carbon Dioxide Insufflation During Peroral Endoscopic Myotomy (U-POEM Trial)
A Patient Blinded, Randomized, Controlled Trial Comparing Right Colon Adenoma Detection Rate in Colonoscopy Using Right Colon Water Exchange and Traditional Air Insufflation
Who cites it
48 citing papers in PubMed, 6 syntheses or guidelines pooled it, 114 citations in OpenAlex.
- EFFICACY OF WATER INFUSION VERSUS AIR/CO2 INSUFFLATION FOR COLONOSCOPY: A SYSTEMATIC REVIEW AND META-ANALYSIS.Arquivos de gastroenterologia · 2026Pooled it
- Adenoma and Advanced Adenoma Detection Rates of Water Exchange, Endocuff, and Cap Colonoscopy: A Network Meta-Analysis with Pooled Data of Randomized Controlled Trials.Digestive diseases and sciences · 2021Pooled it
- Diagnostic application of water exchange colonoscopy: A meta-analysis of randomized controlled trials.The Journal of international medical research · 2019Pooled it
- Water infusion versus air insufflation for colonoscopy.The Cochrane database of systematic reviews · 2015Pooled it
- Is water exchange superior to water immersion for colonoscopy? A systematic review and meta-analysis.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology AssociationPooled it
- Water exchange versus air insufflation for colonoscopy: A meta-analysis.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology AssociationPooled it
- Trial
- Will purposely seeking detect more colorectal polyps than routine performing during colonoscopy?Medicine · 2020Trial
- Underwater versus conventional endoscopic mucosal resection for small size non-pedunculated colorectal polyps: a randomized controlled trial : (UEMR vs. CEMR for small size non-pedunculated colorectal polyps).BMC gastroenterology · 2020Trial
- Water Exchange Method Significantly Improves Adenoma Detection Rate: A Multicenter, Randomized Controlled Trial.The American journal of gastroenterology · 2017Trial
- A randomized controlled trial comparing water exchange and air insufflation during colonoscopy without sedation.International journal of colorectal disease · 2016Trial
- Higher adenoma detection rates with endocuff-assisted colonoscopy - a randomized controlled multicenter trial.PloS one · 2014Trial
- Water Exchange Improves Detection of Advanced Colorectal Neoplasia: Pooled Analysis of Four Randomized Trials.JGH open : an open access journal of gastroenterology and hepatology · 2026Article
- Artificial intelligence alert system based on intraluminal view for colonoscopy intubation.Scientific reports · 2025Article
- Water-assisted colonoscopy in inflammatory bowel diseases: From technical implications to diagnostic and therapeutic potentials.World journal of gastrointestinal endoscopy · 2024Review
- Painless colonoscopy: fact or fiction?Clinical endoscopy · 2024Review
- Water exchange technique improves colonoscopy in patients with spinal cord injury: Results of a matched cohort study.Endoscopy international open · 2024Article
- ENDOANGELTherapeutic advances in gastroenterology · 2023Article
- Risk Factors Associated with Painful Colonoscopy and Prolonged Cecal Intubation Time in Female Patients.Journal of the anus, rectum and colon · 2023Article
- Comparison of Procedural Sequences in Sedated Same-Day Bidirectional Endoscopy with Water-Exchange Colonoscopy: A Randomized Controlled Trial.Journal of clinical medicine · 2022Article
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesMinimal sedation obviates patient recovery burdens, but intolerable pain limits success of cecal intubation. Painless or minimally uncomfortable insertion ensures success of cecal intubation, current patient satisfaction, and willingness to repeat future colonoscopy with minimal sedation. Water immersion (WI) and water exchange (WE), when separately compared with air insufflation (AI), significantly reduced insertion pain. To assess comparative effectiveness, we conducted a randomized controlled trial with head-to-head comparison of these three methods. We hypothesized that WE could produce the highest proportion of patients reporting painless insertion.
methodsThis prospective patient-blinded trial (NCT01535326) enrolled minimally sedated (25 mg intramuscular meperidine) patients randomized to AI, WI, or WE (90 patients/group) to aid insertion. The previously validated primary outcome was the proportion of patients reporting painless insertion.
resultsPainless insertion was reported by 30.0% (AI), 43.3% (WI), and 61.1% (WE) of patients (P<0.001). Multivariate logistic regression analysis revealed that, after adjusting for gender, body mass index, abdominal compression, position change, insertion time to cecum, and length of scope at cecum, only WE was significantly associated with painless insertion compared with AI (odds ratio (OR)=0.08, 95% confidence interval (CI)=0.03-0.24, P<0.001) or WI (OR=0.14, 95% CI=0.05-0.40, P<0.001). Adenoma detection rate (ADR) in the right (cecum and ascending) colon was 11.1% (AI), 14.4% (WI), and 26.7% (WE) (P=0.015). The limitations included single site study with unblinded colonoscopist and assistant.
conclusionsThis head-to-head comparison of AI vs. WI vs. WE confirmed that WE was superior to WI and AI, with a significantly greater proportion of patients reporting painless insertion. The significantly higher ADR in the right colon in the WE group warrants further investigations.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.