Tu1430 Application of the Water Method to Aid Colonoscope Insertion in Community Settings in the United States Is Feasible: Sedation Requirement Can Be Minimized Without Compromising Patient-Centered and Procedure-Related Outcomes

Background/Aims: The water method (WM) decreased patient discomfort and sedation requirement in predominantly male Veteran Affairs (VA) settings (GIE 2010;72:693, GIE 2009;70:505). A peristaltic pump for water infusion in lieu of air insufflation, combined with suction of residual air to minimize angulations at flexures and water exchange to clear residual feces for luminal viewing, is used to open the colon and insert the colonoscope. Applicability in non-VA settings in the United States (US) is unreported. Our aim is to establish feasibility of WM use at 2 non-VA community sites and to compare the WM with air insufflation (AI) at one. We tested the hypothesis that compared with AI patients examined with the WM would require less sedation without adverse impact on outcomes. Methods: Performance improvement projects were carried out at 2 sites. The goal was to minimize patient sedation burden. Experienced colonoscopists at these 2 sites were coached by FWL in 6 colonoscopies each using the WM. Consecutive patients who consented to respond to a questionnaire after colonoscopy were enrolled. Project 1: At the White Memorial Medical Center (WMMC), a community-based teaching hospital, a single endoscopist (AM) performed all reported procedures (Fujinon equipment). The design was single-blinded (patient only); quasi-randomized - odd days (WM), even days (AI). Project 2: At the Loma Linda Medical Center (LLMC), a university-affiliated teaching hospital, a supervised trainee (KC) performed the reported procedures (Olympus equipment). Patient demographics (age, gender and body mass index), amount of sedation required during colonoscopy and procedure-related variables were recorded. The patients completed a questionnaire that enquired about discomfort during colonoscopy and willingness to repeat the procedure within 24 hours after the procedure. The data were prospectively monitored. Permission was obtained from both Institution Review Boards to report the data. Patients were initially given fentanyl 25 mg and midazolam 1 mg i.v. Dosage was increased if they showed common clinical signs of increased discomfort (e.g. verbalized pain sensation, grimaced due to pain in the abdomen, change in vital signs deemed to be due to pain by the colonoscopist). Results: Table. Conclusion: This is the first report documenting feasibility of WM as the principal modality to aid colonoscope insertion in both male and female community patients in the US. In a head-to-head comparison at one site, significant reduction of sedation requirement is confirmed as hypothesized. Patient-centered (discomfort, willingness to repeat) and procedure-related (examination duration, adenoma detection) outcomes were not compromised. The current data do not substantiate the concern over WM prolonging total procedure time previously reported in a proof-of-concept study in the VA setting. (Table presented).