Colonoscopy with the water immersion method in colorectal cancer screening
Keywords:
colonoscopy with the water method, adenomas, colorectal cancer.Abstract
Introduction: Colonoscopy is useful for the diagnosis and treatment of colorectal diseases. It is used as a method of detecting malignant diseases. Most cases of colorectal cancer originate from an adenoma, a process known as the adenoma-carcinoma sequence. Removal of advanced adenomas interrupts the potential pathway for colorectal cancer development. The water method of colonoscopy increases the detection rate of adenomas.
Objective: To update knowledge related to colonoscopy with the method of immersion in water.
Development: Water-assisted colonoscopy can be subdivided into water immersion, water exchange, or totally underwater. Both immersion and water exchange colonoscopy produce less pain for the patient and reduce the need for sedation medications, with a higher percentage of colonoscopies completed in awake patients. The use of water improves the detection of adenomas by facilitating greater cleaning of the intestine of residual feces, in addition to allowing inspection of the mucosa without completely distending the light as air does, increasing the detection performance of flat lesions.
Conclusions: The detection rate of adenomas with the water method, especially at the level of the right colon, is higher than with the air insufflation method.
Downloads
Download data is not yet available.
References
1. Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D, et al. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2019; 69(3):184-210. DOI: 10.3322/caac.21557
2. Montes de Oca Megías E, Noa Pedroso G, García Jordá E, Seijas Cabrera O, Pérez Triana F, Brizuela Quintanilla R. La colonoscopia como prueba de oro para la pesquisa del cáncer colorrectal. Rev Cubana Med. 2013 [acceso: 27/07/2022]; 52(1): 60-71. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232013000100007&lng=es
3. Domínguez L, Chávez MA, Manrique MA, Tapia M, Méndez DV, Velásquez O, et al. Seguridad y eficacia de la colonoscopia en el adulto mayor en la unidad de Endoscopia del Hospital Juárez de México. Endoscopía. 2020 [acceso: 17/10/2022]; 32(2):135-40. Disponible en: https://www.scielo.org.mx/pdf/endo/v32s2/0188-9893-endo-32-supl2-135.pdf
4. Alfaro AA, Manrique A, Chávez MA, Cerna J. Colonoscopia de intercambio mínimo de agua y su impacto en el índice de detección de pólipos: estudio aleatorizado. Endoscopia. 2019 [acceso: 17/10/2022]; 31(2):260-6. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2444-64832019000600260&lng=es
5. Santodomingo C, Zuramay C. Eficacia de la colonoscopia con la técnica de inmersión de agua comparada con la técnica de colonoscopia convencional. Endoscopia. 2016; 26(2):43-50. DOI: 10.1016/j.endomx.2013.10.002
6. Leung FW. Methods of reducing discomfort during colonoscopy. Digestive diseases and sciences. 2008; 53(6):1462-7. DOI: 10.1007/s10620-007-0025-9
7. Jia H, Pan Y, Guo X, Zhao L, Wang X, Zhang L, et al. Water Exchange Method Significantly Improves Adenoma Detection Rate: A Multicenter, Randomized Controlled Trial. American Journal of Gastroenterology. 2017; 112(4):568-76. DOI: 10.1038/ajg.2016.501
8. Hsieh Y, Tseng C, Hu C, Koo M, Leung FW. Prospective multicenter randomized controlled trial comparing adenoma detection rate in colonoscopy using water exchange, water immersion, and air insufflations. Gastrointestinal Endoscopy. 2017; 86(1):192-201. DOI: 10.1016/j.gie.2016.12.005
9. Asai S, Fujimoto N, Tanoue K, Nakao E, Hashimoto K, Ichinona T, et al. Water immersion colonoscopy facilitates straight passage of the colonoscope through the sigmoid colon without loop formation: randomized controlled trial. Dig Endosc. 2015; 27(3):345-53. DOI: 10.1111/den.12406
10. Azevedo R, Leitão C, Pinto J, Ribeiro H, Pereira F, Caldeira A, et al. Can water exchange improve patient tolerance in unsedated colonoscopy a prospective comparative study.GE Port J Gastroenterol. 2018; 25(4):166-74. DOI: 10.1159/000484093
11. Hafner S, Zolk K, Radaelli F, Otte J, Rabenstein T, Zolk O. Water infusion versus air insufflations for colonoscopy. Cochrane Database Systemic Reviews. 2015; 26(5):CD009863. DOI: 10.1002/14651858
12. Rodríguez-Fernández Z, de-Wayne-Brown M, Cisneros-Domínguez C, Romero-García L, Ricardo-Ramírez J. Especificidades clínico-epidemiológicas y diagnósticas del cáncer de colon con metástasis hepáticas sincrónicas. Revista Cubana de Cirugía. 2021 [acceso: 27/07/2022]; 60(1):1-17 Disponible en: http://www.revcirugia.sld.cu/index.php/cir/article/view/1020
13. Maple JT, Banerjee S, Barth BA, Bhat YM, Desilets DJ, Gottlieb KT, et al. Methods of luminal distention for colonoscopy. Gastrointestinal Endoscopy. 2013; 77(4):519-25. DOI: 10.1016/j.gie.2012.09.025
14. Abdelbary M, Hamdy S, Shehab H, E Garhy N, Menesy M, Marzaban R. Técnicas colonoscópicas para la detección de pólipos: un estudio egipcio. Revista de Gastroenterología de México . 2021 [acceso: 27/07/2022]; 86(1):36-43. Disponible en: https://www.sciencedirect.com/science/article/pii/S0375090620300768
15. Kaminski MF, Thomas-Gibson S, Bugajski M, Bretthauer M, Rees CJ, Dekker E, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. 2017; 49(4):378-397. DOI: 10.1055/s-0043-103411
16. Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, et al. Quality indicators for colonoscopy. Gastrointestinal Endoscopy. 2015; 81(1):31-53. DOI: 10.1016/j.gie.2014.07.058
17. Segal JP, Kanagasundaram C, Mills P, Bassett P, Greenfield SM. Polyp detection rate: does length matter? Frontline Gastroenterol. 2019; 10(2):107-12. DOI: 10.1136/flgastro-2017-100945
18. Anderson JC. Use of Total Under Water Colonoscopy to Navigate Endoscopic Challenges. Clinical Gastroenterology and Hepatology. 2020; 18(7):1427-1430. DOI: 10.1016/j.cgh.2020.02.042
19. Catinean A, Neag MA, Tulbure M. The advantages of water immersion colonoscopy in ambulatory service. Turkish Journal of Gastroenterology. 2019; 30(7):636-40. DOI: 10.5152/tjg.2019.18784
20. Leung FW, Leung JW, Siao-Salera RM, Mann SK, Jackson G. The water method significantly enhances detection of diminutive lesions (adenoma and hyperplastic polyp combined) in the proximal colon in screening colonoscopy - data derived from two RCT in US veterans. J Interv Gastroenterol. 2011; 1(2):48-52. DOI: 10.4161/jig.1.2.16826
21. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492
22. Vanegas Morenoa DP, Ramírez López LX, Limas Solanoc LM,Pedraza Bernal AM, Monroy Díaz AL. Factores asociados a cáncer colorrectal. Rev. Méd. Risaralda. 2020; 26(1):68-77. DOI 10.22517/25395203.23111
23. Utrera-Díaz G, Pérez-Rodríguez L, Toledo-Yanes P. Cáncer colorrectal: Factores de riesgo en pacientes mayores de 50años en Cienfuegos. Revista Finlay. 2021 [acceso: 27/07/2022]; 11(3):[aprox. 6 p.]. Disponible en: http://www.revfinlay.sld.cu/index.php/finlay/article/view/920
24. Ministerio de Salud Pública. Anuario estadístico de salud 2019. La Habana: Dirección de registros médicos y estadísticas de salud; 2020. Disponible en: https://files.sld.cu/bvscuba/files/2020/05/Anuario-Electrónico-Español-2019-ed-2020.pdf
25. Hernández García A. Análisis de los factores pronósticos en el cáncer de colon estadios II y III [Tesis Doctoral]. Zaragoza: Universidad de Zaragoza; 2018 [acceso: 27/07/2022]. Disponible en: https://zaguan.unizar.es/record/79653/files/TESIS-2019-130.pdf
26. Burgos H. Estándares de calidad en videocolonoscopía. Acta Gastroenterol Latinoam 2020 [acceso: 17/10/2022]; 50(4):25-31. Disponible en: https://actagastro.org/estandares-de-calidad-en-videocolonoscopia/
27. Calderón Reza JC. Cáncer de colon, secuencia adenoma carcinoma y pólipo aserrado. 2018 [acceso: 27/07/2022]; 14(62):52-55. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1990-86442018000200008&lng=es&tlng=es
28. Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. American Journal of Gastroenterology, 2017; 112(7):1016-30. DOI: 10.1038/ajg.2017.174
29. Shaukat A, Rector TS, Church TR, Lederle FA, Kim AS, Rank JM, et al. Longer Withdrawal Time Is Associated with a Reduced Incidence of Interval Cancer After Screening Colonoscopy. Gastroenterology. 2015; 149(4):952-7. DOI: 10.1053/j.gastro.2015.06.044
30. Shaw AT, Engelman JA. Adenoma Detection Rate and Risk of Colorectal Cancer and. N Engl J Med. 2014; 370(26):2537-9. DOI: 10.1056/NEJMoa1309086
31. Chen Z, Li Z, Yu X, Wang G. Is water exchange superior to water immersion for colonoscopy? A systematic review and meta-analysis. Saudi J Gastroenterol. 2018; 24(5):259-67. DOI: 10.4103/sjg.SJG_52_18
32. Anderson JC, Kahi CJ, Sullivan A, MacPhail M, Garcia J, Rex DK. Comparing adenoma and polyp miss rates for total under water colonoscopy versus standard CO2: a randomized controlled trial using a tandem colonoscopy approach. Gastrointestinal Endoscopy. 2019; 89(3):591-8. DOI: 10.1016/j.gie.2018.09.046
33. Siau K, Beintaris I. My approach to water-assisted colonoscopy. Frontline Gastroenterology. 2019; 10(2):194-7. DOI: 10.1136/flgastro-2018-101143
34. Leung FW, Jia H. Expert endorsement, a prerequisite to general acceptance, marked a significant milestone in the history of water exchange colonoscopy. Gastrointestinal Endoscopy. 2018; 88(4):598-600. DOI: 10.1016/j.gie.2018.08.001
2. Montes de Oca Megías E, Noa Pedroso G, García Jordá E, Seijas Cabrera O, Pérez Triana F, Brizuela Quintanilla R. La colonoscopia como prueba de oro para la pesquisa del cáncer colorrectal. Rev Cubana Med. 2013 [acceso: 27/07/2022]; 52(1): 60-71. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232013000100007&lng=es
3. Domínguez L, Chávez MA, Manrique MA, Tapia M, Méndez DV, Velásquez O, et al. Seguridad y eficacia de la colonoscopia en el adulto mayor en la unidad de Endoscopia del Hospital Juárez de México. Endoscopía. 2020 [acceso: 17/10/2022]; 32(2):135-40. Disponible en: https://www.scielo.org.mx/pdf/endo/v32s2/0188-9893-endo-32-supl2-135.pdf
4. Alfaro AA, Manrique A, Chávez MA, Cerna J. Colonoscopia de intercambio mínimo de agua y su impacto en el índice de detección de pólipos: estudio aleatorizado. Endoscopia. 2019 [acceso: 17/10/2022]; 31(2):260-6. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2444-64832019000600260&lng=es
5. Santodomingo C, Zuramay C. Eficacia de la colonoscopia con la técnica de inmersión de agua comparada con la técnica de colonoscopia convencional. Endoscopia. 2016; 26(2):43-50. DOI: 10.1016/j.endomx.2013.10.002
6. Leung FW. Methods of reducing discomfort during colonoscopy. Digestive diseases and sciences. 2008; 53(6):1462-7. DOI: 10.1007/s10620-007-0025-9
7. Jia H, Pan Y, Guo X, Zhao L, Wang X, Zhang L, et al. Water Exchange Method Significantly Improves Adenoma Detection Rate: A Multicenter, Randomized Controlled Trial. American Journal of Gastroenterology. 2017; 112(4):568-76. DOI: 10.1038/ajg.2016.501
8. Hsieh Y, Tseng C, Hu C, Koo M, Leung FW. Prospective multicenter randomized controlled trial comparing adenoma detection rate in colonoscopy using water exchange, water immersion, and air insufflations. Gastrointestinal Endoscopy. 2017; 86(1):192-201. DOI: 10.1016/j.gie.2016.12.005
9. Asai S, Fujimoto N, Tanoue K, Nakao E, Hashimoto K, Ichinona T, et al. Water immersion colonoscopy facilitates straight passage of the colonoscope through the sigmoid colon without loop formation: randomized controlled trial. Dig Endosc. 2015; 27(3):345-53. DOI: 10.1111/den.12406
10. Azevedo R, Leitão C, Pinto J, Ribeiro H, Pereira F, Caldeira A, et al. Can water exchange improve patient tolerance in unsedated colonoscopy a prospective comparative study.GE Port J Gastroenterol. 2018; 25(4):166-74. DOI: 10.1159/000484093
11. Hafner S, Zolk K, Radaelli F, Otte J, Rabenstein T, Zolk O. Water infusion versus air insufflations for colonoscopy. Cochrane Database Systemic Reviews. 2015; 26(5):CD009863. DOI: 10.1002/14651858
12. Rodríguez-Fernández Z, de-Wayne-Brown M, Cisneros-Domínguez C, Romero-García L, Ricardo-Ramírez J. Especificidades clínico-epidemiológicas y diagnósticas del cáncer de colon con metástasis hepáticas sincrónicas. Revista Cubana de Cirugía. 2021 [acceso: 27/07/2022]; 60(1):1-17 Disponible en: http://www.revcirugia.sld.cu/index.php/cir/article/view/1020
13. Maple JT, Banerjee S, Barth BA, Bhat YM, Desilets DJ, Gottlieb KT, et al. Methods of luminal distention for colonoscopy. Gastrointestinal Endoscopy. 2013; 77(4):519-25. DOI: 10.1016/j.gie.2012.09.025
14. Abdelbary M, Hamdy S, Shehab H, E Garhy N, Menesy M, Marzaban R. Técnicas colonoscópicas para la detección de pólipos: un estudio egipcio. Revista de Gastroenterología de México . 2021 [acceso: 27/07/2022]; 86(1):36-43. Disponible en: https://www.sciencedirect.com/science/article/pii/S0375090620300768
15. Kaminski MF, Thomas-Gibson S, Bugajski M, Bretthauer M, Rees CJ, Dekker E, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. 2017; 49(4):378-397. DOI: 10.1055/s-0043-103411
16. Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, et al. Quality indicators for colonoscopy. Gastrointestinal Endoscopy. 2015; 81(1):31-53. DOI: 10.1016/j.gie.2014.07.058
17. Segal JP, Kanagasundaram C, Mills P, Bassett P, Greenfield SM. Polyp detection rate: does length matter? Frontline Gastroenterol. 2019; 10(2):107-12. DOI: 10.1136/flgastro-2017-100945
18. Anderson JC. Use of Total Under Water Colonoscopy to Navigate Endoscopic Challenges. Clinical Gastroenterology and Hepatology. 2020; 18(7):1427-1430. DOI: 10.1016/j.cgh.2020.02.042
19. Catinean A, Neag MA, Tulbure M. The advantages of water immersion colonoscopy in ambulatory service. Turkish Journal of Gastroenterology. 2019; 30(7):636-40. DOI: 10.5152/tjg.2019.18784
20. Leung FW, Leung JW, Siao-Salera RM, Mann SK, Jackson G. The water method significantly enhances detection of diminutive lesions (adenoma and hyperplastic polyp combined) in the proximal colon in screening colonoscopy - data derived from two RCT in US veterans. J Interv Gastroenterol. 2011; 1(2):48-52. DOI: 10.4161/jig.1.2.16826
21. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492
22. Vanegas Morenoa DP, Ramírez López LX, Limas Solanoc LM,Pedraza Bernal AM, Monroy Díaz AL. Factores asociados a cáncer colorrectal. Rev. Méd. Risaralda. 2020; 26(1):68-77. DOI 10.22517/25395203.23111
23. Utrera-Díaz G, Pérez-Rodríguez L, Toledo-Yanes P. Cáncer colorrectal: Factores de riesgo en pacientes mayores de 50años en Cienfuegos. Revista Finlay. 2021 [acceso: 27/07/2022]; 11(3):[aprox. 6 p.]. Disponible en: http://www.revfinlay.sld.cu/index.php/finlay/article/view/920
24. Ministerio de Salud Pública. Anuario estadístico de salud 2019. La Habana: Dirección de registros médicos y estadísticas de salud; 2020. Disponible en: https://files.sld.cu/bvscuba/files/2020/05/Anuario-Electrónico-Español-2019-ed-2020.pdf
25. Hernández García A. Análisis de los factores pronósticos en el cáncer de colon estadios II y III [Tesis Doctoral]. Zaragoza: Universidad de Zaragoza; 2018 [acceso: 27/07/2022]. Disponible en: https://zaguan.unizar.es/record/79653/files/TESIS-2019-130.pdf
26. Burgos H. Estándares de calidad en videocolonoscopía. Acta Gastroenterol Latinoam 2020 [acceso: 17/10/2022]; 50(4):25-31. Disponible en: https://actagastro.org/estandares-de-calidad-en-videocolonoscopia/
27. Calderón Reza JC. Cáncer de colon, secuencia adenoma carcinoma y pólipo aserrado. 2018 [acceso: 27/07/2022]; 14(62):52-55. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1990-86442018000200008&lng=es&tlng=es
28. Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. American Journal of Gastroenterology, 2017; 112(7):1016-30. DOI: 10.1038/ajg.2017.174
29. Shaukat A, Rector TS, Church TR, Lederle FA, Kim AS, Rank JM, et al. Longer Withdrawal Time Is Associated with a Reduced Incidence of Interval Cancer After Screening Colonoscopy. Gastroenterology. 2015; 149(4):952-7. DOI: 10.1053/j.gastro.2015.06.044
30. Shaw AT, Engelman JA. Adenoma Detection Rate and Risk of Colorectal Cancer and. N Engl J Med. 2014; 370(26):2537-9. DOI: 10.1056/NEJMoa1309086
31. Chen Z, Li Z, Yu X, Wang G. Is water exchange superior to water immersion for colonoscopy? A systematic review and meta-analysis. Saudi J Gastroenterol. 2018; 24(5):259-67. DOI: 10.4103/sjg.SJG_52_18
32. Anderson JC, Kahi CJ, Sullivan A, MacPhail M, Garcia J, Rex DK. Comparing adenoma and polyp miss rates for total under water colonoscopy versus standard CO2: a randomized controlled trial using a tandem colonoscopy approach. Gastrointestinal Endoscopy. 2019; 89(3):591-8. DOI: 10.1016/j.gie.2018.09.046
33. Siau K, Beintaris I. My approach to water-assisted colonoscopy. Frontline Gastroenterology. 2019; 10(2):194-7. DOI: 10.1136/flgastro-2018-101143
34. Leung FW, Jia H. Expert endorsement, a prerequisite to general acceptance, marked a significant milestone in the history of water exchange colonoscopy. Gastrointestinal Endoscopy. 2018; 88(4):598-600. DOI: 10.1016/j.gie.2018.08.001
Published
2023-03-01
How to Cite
1.
Tusen Toledo Y, Chao González L, Barroso Márquez L, Martínez Leyva L, Pérez González T, Rodríguez Rodríguez H. Colonoscopy with the water immersion method in colorectal cancer screening. Rev Cubana Med Milit [Internet]. 2023 Mar. 1 [cited 2025 Mar. 14];52(2):e02302330. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/2330
Issue
Section
Review Article
License
Authors who have publications with this Journal accept the following terms:
- The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
- The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
- Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.
