Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations.
Donatella Mura, Maximilien Barret, Putut Bayupurnama, Ramsey Cheung, Hey-Long Ching, Hartley Cohen, Shai Friedland, Hideaki Harada, Yu-Hsi Hsieh, Bu Hayee, Toshio Kuwai, Vicente Lorenzo-Zúñiga, Mauro Liggi, Takeshi Mizukami, Adrian Bak, David Nylander, Snorri Olafsson, Silvia Paggi, Yanglin Pan, Adolfo Parra-Blanco, Rupert Ransford, Joaquìn Rodriguez-Sanchez, Hakan Senturk, Noriko Suzuki, Chih-Wei Tseng, Hugo Uchima, Noriya Uedo, Felix W Leung, Pradeep Bhandari, Sergio Cadoni, Sauid Ishaq, Cesare Hassan, Přemysl Falt, Lorenzo Fuccio, Keith Siau, Joseph W Leung, John Anderson, Kenneth F Binmoeller, Franco Radaelli, Matt D Rutter, Shinya Sugimoto, Humayun Muhammad, Sunil Dolwani, Peter V Draganov, Piet de Groen, Andrew Y Wang, Andrew W Yen, Chris Hamerski, Henrik Thorlacius, Helmut Neumann, Francisco Ramirez, Chris J J Mulder, Eduardo Albéniz, Arnaldo Amato, Makoto Arai
Journal: Gastrointestinal endoscopy
2021;93(6):1411-1420.e18
PMID: 33069706
Abstract
BACKGROUND AND AIMS
Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR.
METHODS
Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements.
RESULTS
In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11).
CONCLUSIONS
The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.
Copyright © 2021 American Society for Gastrointestinal Endoscopy. All rights reserved.
Address:
CTO Hospital, Digestive Endoscopy Unit, Iglesias, Italy.; Russell Hall, Dept. of Gastroenterology, Birmingham, United Kingdom; Birmingham City University, Birmingham, United Kingdom.; Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy.; University Hospital and Faculty of Medicine, Palacky University, Olomouc, Czech Republic; Faculty of Medicine, Charles University, Hradec Králové, Czech Republic.; S. Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, Bologna, Italy.; JAG Clinical Fellow, JAG, Royal College of Physicians, London, United Kingdom.; Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and University of California Davis School of Medicine, Sacramento, California, USA.; Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom.; California Pacific Medical Center, Interventional Endoscopy Services, San Francisco, California, United States.; Ospedale Valduce, Gastroenterology Unit, Como, Italy.; University Hospital North Tees NHS, Department of Gastroenterology, Stockton-on-Tees, United Kingdom; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom.; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.; University of Roehampton, London, United Kingdom.; Portsmouth University Hospital, Dept. of Gastroenterology, Portsmouth, United Kingdom.; University of Florida, Gainesville, Florida, United States.; University of Minnesota, Division of Gastroenterology, Minneapolis, Minnesota, United States.; Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States.; Lund University Surgery, Department of Gastrointestinal Surgery, Malmö, Sweden.; University Medical Center, Interventional Endoscopy Center, Medizinische Klinik und Poliklinik, Mainz, Germany.; Mayo Clinic, Scottsdale, Arizona, United States.; VU University Medical Center, Department of Gastroenterology, Amsterdam, The Netherlands.; Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.; Chiba University, Gastroenterology Department, Chiba, Japan.; University of British Columbia, Department of Medicine, Kelowna, Canada.; Cochin Hospital, Gastroenterology Department, Paris, France.; Division of Gastroenterology and Hepatology, Internal Medicine Department, Faculty of Medicine, Gadjah Mada University, Sardjito General Hospital, Yogyakarta, Indonesia.; Division of Gastroenterology and Hepatology, Stanford University School of Medicine, VA Palo Alto, California, United States.; Sheffield Teaching Hospitals, Gastroenterology Department, Sheffield, United Kingdom.; Department of Medicine, VA Greater Los Angeles Health Care System, Los Angeles, United States; David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California, United States.; Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom.; Department of Gastroenterology, New Tokyo Hospital, Gastroenterology, Matsudo, Chiba, Japan.; Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan.; King's College Hospital NHS foundation Trust, Gastroenterology Department, London, United Kingdom.; NHO Kure Medical Center and Chugoku Cancer Center, Gastroenterology Department, Kure, Japan.; Endoscopy Unit, University Hospital La Fe, Valencia, Spain.; ASSL Carbonia, Sirai Hospital, Digestive Endoscopy Unit, Carbonia, Italy.; NHO Kurihama Medical and Addiction Center, Endoscopy Center, Yokosuka, Japan.; Newcastle Upon Tyne NHS Foundation Trust, Gastroenterology Department, Newcastle Upon Tyne, United Kingdom.; Telemark Hospital, Gastroenterology Department, Skien, Norway.; Xijing Hospital, Department of Gastroenterology, Xian, Republic of China.; NIHR Nottingham Biomedical Research Centre, Department of Gastroenterology, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom.; Endoscopy Department Hereford County Hospital, Hereford, United Kingdom.; Endoscopy Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.; Bezmialem Vakif University Medicine Faculty, Department of Medicine, Istanbul, Turkey.; Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom.; Hospital Germans Triasi i Pujol, Teknon Medical Center, Gastroenterology, Barcelona, Spain.; Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan.
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