Trial reportThe American journal of gastroenterology2017
Water Exchange Method Significantly Improves Adenoma Detection Rate: A Multicenter, Randomized Controlled Trial.
Trial report in The American journal of gastroenterology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 41 papers, 4 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.
Abdominal Compression Administered Early by the Colonoscopist Shortened Insertion Time of Water Exchange Colonoscopy
Effect of Water Exchange Plus Acetic Acid Staining on the Detection of Flat Polyps During Screening and Surveillance Colonoscopy: a Multi-centered, Randomized Controlled Study.
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
41 citing papers in PubMed, 4 syntheses or guidelines pooled it, 97 citations in OpenAlex.
- Effectiveness of artificial intelligence-assisted colonoscopy in detecting and diagnosing colorectal tumors: a systematic review and network meta-analysis.International journal of colorectal disease · 2025Pooled 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 exchange versus air insufflation for colonoscopy: A meta-analysis.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology AssociationPooled it
- Comparing right colon adenoma detection rate during water exchange and air insufflation: a double-blind randomized controlled trial.Techniques in coloproctology · 2022Trial
- Risk Factors Associated with Inadequate Bowel Preparation in Patients with Functional Constipation.Digestive diseases and sciences · 2020Trial
- Trial
- A prospective RCT comparing combined chromoendoscopy with water exchange (CWE) vs water exchange (WE) vs air insufflation (AI) in adenoma detection in screening colonoscopy.United European gastroenterology journal · 2019Trial
- Association between gastrointestinal lesions in individuals undergoing gastroscopy and colonoscopy simultaneously: a retrospective, observational study.BMC gastroenterology · 2025Observational
- Water-assisted colonoscopy in inflammatory bowel diseases: From technical implications to diagnostic and therapeutic potentials.World journal of gastrointestinal endoscopy · 2024Review
- Water exchange technique improves colonoscopy in patients with spinal cord injury: Results of a matched cohort study.Endoscopy international open · 2024Article
- Randomised controlled trials of non-pharmacological interventions to improve patient-reported outcomes of colonoscopy: a scoping review.BMJ open gastroenterology · 2023Article
- Efficacy of image-enhanced endoscopy for colorectal adenoma detection: A multicenter, randomized trial.World journal of gastrointestinal oncology · 2023Article
- Protocol design for randomized clinical trial to compare underwater cold snare polypectomy to conventional cold snare polypectomy for non-pedunculated colon polyps of size 5-10 mm (COLDWATER study).Techniques in coloproctology · 2023Article
- ENDOANGELTherapeutic advances in gastroenterology · 2023Article
- FIT-based risk-stratification model effectively screens colorectal neoplasia and early-onset colorectal cancer in Chinese population: a nationwide multicenter prospective study.Journal of hematology & oncology · 2022Article
- Computer-Aided Detection False Positives in Colonoscopy.Diagnostics (Basel, Switzerland) · 2021Review
- Frontiers of Robotic Colonoscopy: A Comprehensive Review of Robotic Colonoscopes and Technologies.Journal of clinical medicine · 2020Review
- Comparison of application value between conventional air insufflation and water infusion in colonoscopy.International journal of clinical and experimental pathology · 2020Article
- Water assistance: also for sigmoidoscopy?Endoscopy international open · 2020Article
Corrections and comments
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Authors and funding
26 authors at 11 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAdenoma detection rate (ADR) is a key colonoscopy quality indicator in Western clinical literature. Our low ADR prompted us to assess novel methods to improve performance. Western retrospective reports suggested that water exchange (WE) could increase ADR. However, most of these studies used pain score or intubation rate as the primary outcome. Here we test the hypothesis that WE significantly increases ADR among Chinese colonoscopists and design a prospective randomized controlled trial using ADR as our primary outcome.
methodsThis prospective, randomized controlled trial was performed at six centers in China. Screening, surveillance, and diagnostic cases were randomized to be examined by WE or traditional air insufflation (AI) method. The primary outcome was ADR.
resultsFrom April 2014 to July 2015, 3,303 patients were randomized to WE (n=1,653) and AI (n=1,650). The baseline characteristics were comparable. Overall ADR was 18.3% (WE) and 13.4% (AI) (relative risk 1.45, 95% confidential interval: 1.20-1.75, P<0.001). ADR in screening patients using AI was 25.8% (male) and 15.7% (female). ADR in screening patients aged >50 years old was 29.4% (WE) and 22.9% (AI) (relative risk 1.09, 95% confidential interval: 1.00-1.19, P=0.040). The increase by WE was reproducibly observed in all indication categories, and significant in screening and diagnostic cases. The limitation imposed by the unblinded investigators was mitigated by comparable inspection times in cases without polyps, similar adenoma per positive colonoscopy, and reproducible enhancement of ADR and adenoma per colonoscopy by WE across all eight investigators.
conclusionsThis prospective study confirms Western retrospective data that WE significantly improves ADR among Chinese colonoscopists. WE may be superior to AI for screening colonoscopy in China. Colonoscopists elsewhere with low ADR might consider evaluating WE for performance improvement.
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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.