A survey of colonoscopists with and without in-depth knowledge of water-aided colonoscopy

Felix W. Leung, Sergio Cadoni, Malcolm Koo, Andrew W. Yen, Keith Siau, Yu Hsi Hsieh, Sauid Ishaq, Chi Liang Cheng, Francisco C. Ramirez, Adrian W. Bak, William Karnes, Putut Bayupurnama, Joseph W. Leung, Piet C. de Groen

Research output: Contribution to journalArticlepeer-review


Background and Aim: Endoscopy featured water-aided colonoscopy (WAC) as novel in the Innovation Forum in 2011. Gastrointestinal Endoscopy published a modified Delphi consensus review (MDCR) that supports WAC for clinical practice in 2021. We tested the hypothesis that experience was an important predictor of WAC use, either as water immersion (WI), water exchange (WE), or a combination of WI and WE. Methods: A questionnaire was sent by email to the MDCR authors with an in-depth knowledge of WAC. They responded and also invited colleagues and trainees without in-depth knowledge to respond. Logistic regression analysis was used with the reasons for WAC use treated as the primary outcome. Reports related to WAC post MDCR were identified. Results: Of 100 respondents, > 80% indicated willingness to adopt and modify practice to accommodate WAC. Higher adenoma detection rate (ADR) incentivized WE use. Procedure time slots ≤ 30 and > 30 min significantly predicted WI and WE use, respectively. Co-authors of the MDCR were significantly more likely to perform WAC (odds ratio [OR] = 7.5, P = 0.037). Unfamiliarity with (OR = 0.11, P = 0.02) and absence of good experience (OR = 0.019, P = 0.002) were associated with colonoscopists less likely to perform WAC. Reports related to WAC post MDCR revealed overall and right colon WE outcomes continued to improve. Network meta-analyses showed that WE was superior to Cap and Endocuff. On-demand sedation with WE shortened nursing recovery time. Conclusions: An important predictor of WAC use was experience. Superior outcomes continued to be reported with WE.

Original languageEnglish (US)
Pages (from-to)1785-1791
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Issue number9
StatePublished - Sep 2022

Bibliographical note

Funding Information:
The authors acknowledge the contributions of the survey respondents. This study was supported in part by VA Merit and ASGE clinical research funds (FWL). The responses were de‐identified by Murphy Chen (MC). This material is also the result of work supported by resources from the Department of Veterans Affairs. The contents reported/presented within do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.

Publisher Copyright:
© 2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.


  • survey
  • water exchange
  • water immersion
  • water-aided colonoscopy

PubMed: MeSH publication types

  • Journal Article
  • Meta-Analysis


Dive into the research topics of 'A survey of colonoscopists with and without in-depth knowledge of water-aided colonoscopy'. Together they form a unique fingerprint.

Cite this