AB005. SOH24AB_207. Water immersion technique for colonoscopy: a video vignette

Background: Colonoscopy facilitates direct visualisation of the colon and biopsy of suspicious lesions and removal of polyps amenable to endoscopic resection. Insertion of the colonoscope is done traditionally via insufflation of the bowel with CO2 however water can be used as an adjunct or substitute. We aim to demonstrate the benefits of the water immersion technique for colonoscopic insertion to the caecum with video evidence.

Methods: Insufflation of the bowel with water is used solely during insertion to the caecum. The continuous spray of water guides navigation along the folds of the colonic mucosa. At caecal intubation, only then air insufflation is used to identify and manage colonic pathology.

Results: The main challenges encountered in colonoscopy include excessive looping, redundant colons and those with severe angulation. Use of water immersion can facilitate a narrower distension and shorter insertion distance compared to gas insufflation leading to improved procedure length and more importantly patient comfort. Water helps to weigh down the sigmoid colon especially in the left lateral decubitus position resulting in a straighter and less redundant sigmoid colon to navigate. Based on the evidence, there is no compromise of any aspects of the colonoscopy with water immersion.

Conclusions: Our department has observed notable improvements in patient comfort scores, reduced sedation needs, quicker recovery, more efficient endoscopy processes including improved caecal intubation rates and polyp detection. These observations have led to the adoption of water immersion colonoscopy as a standard practice in our unit.

Keywords: Water immersion; endoscopy; colorectal; improved polyp detection; improved patient comfort scores