Comparison of water infusion and air insufflation as scope insertion technique in the training of primary care physicians for screening flexible sigmoidoscopy: a randomized controlled trial
Refereed conference paper presented and published in conference proceedings


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AbstractBackground: Colonoscopy and flexible sigmoidoscopy (FS) are acceptable options for colorectal cancer (CRC) screening in major guidelines. In countries where colonoscopy may not be widely available for CRC screening, FS is an attractive option. Recently, the use of water infusion (WI) and water exchange techniques have been shown to reduce patient discomfort during colonoscope insertion and to increase the success rate of unsedated colonoscopy, but data on the utility of WI in screening FS is limited. This study aims to evaluate the impact of WI as scope insertion technique in the training of primary care physicians (PCP) for screening FS.
Methods: Asymptomatic patients aged 50 to 70 suitable for CRC screening were invited for the study. Patients received both FIT and FS for CRC screening in this study. 8 PCPs without prior endoscopy experience received training for screening FS under supervision by attending gastroenterologists. Trainees were randomized to use either WI or air insufflation (AI) during scope insertion. Air insufflation was used during scope withdrawal. Trainees were mandated to complete ≥ 50 FS per person. Complete FS insertion is defined as passage of endoscope to at least 50cm from the anal verge or to descending colon. Trainees were allowed a maximum of 10 minutes for unassisted scope insertion. Outcome measures: mean percentage of unassisted complete FS insertion within 10 minutes using WI or AI in the initial 40 FS, patient discomfort, mean insertion time for complete FS, mean scope withdrawal time, adenoma detection rate (ADR) of left colon.
Results: A total of 408 FS were performed by 8 trainees (201 in WI group, 207 in AI group). The baseline characteristics of patients in WI and AI groups were similar. The mean percentage of unassisted complete FS insertion within 10 minutes using WI or AI were 68.8% vs 79.4%, p=0.041 in the initial 40 FS, and 70.6% vs 79.2%, p=0.052 in the overall FS training, respectively. The mean percentage of unassisted complete FS insertion from the 41st FS and beyond were similar in both groups (78.0% vs 78.7%, p=1). The mean intra-endoscopy pain score (4.0/10 vs 4.0/10, p= 0.977) and the mean scope insertion time (8.3 vs 7.8mins, p=0.207) were similar in both groups. The scope withdrawal time was significantly longer (11.1 vs 7.9mins, p=0.001), and ADR of left colon was significantly higher in the WI group (14.9% vs 8.2%, p=0.043).
Conclusion: When compared to AI, the use of WI as scope insertion technique during FS training in PCP resulted in a lower rate of unassisted complete FS insertion within 10 minutes in the initial 40 FS, but was associated with a longer withdrawal time and a higher ADR in the left colon in this study. The rate of unassisted complete FS insertion from the 41st FS and beyond, patient discomfort, and insertion time were similar between WI group and AI group.
All Author(s) ListTang RSY, Kyaw MH, Lam KLY, Lam TYT, Ho AMY, Ching JYL, Wong MCS, Lau JYW, Wu JCY
Name of ConferenceDigestive Disease Week 2018
Start Date of Conference02/06/2018
End Date of Conference05/06/2018
Place of ConferenceWashington DC
Country/Region of ConferenceUnited States of America
Proceedings TitleGastroenterology
Year2018
Volume Number154
Issue Number6
PublisherElsevier
Place of PublicationUSA
PagesS578 - S579
LanguagesEnglish-United States
Keywordssigmoidoscopy, colorectal cancer

Last updated on 2018-03-07 at 15:13