Feasibility and outcomes of colonoscopy with combined carbon dioxide insufflation and water infusion for resection of colonic polyps

Objective: Traditional air insufflation colonoscopy (AIC) induces pain, discomfort, and even intolerance during insertion of the scope into the cecum. Although sedation/analgesia suppresses abdominal pain and intolerance, sedation-associated complications are possible in some patients. This perspective study assessed the feasibility of colonoscopies that combine carbon dioxide insufflation with water infusion during colonic polypectomy. Methods: Between December 2015 and December 2016, 102 patients were randomly allocated to undergo resection of colonic polyps by either water-aided colonoscopy (WAC) (n = 50) or conventional AIC (n = 52). Patients were assessed for pain, cecal intubation, on-demand sedation/analgesia, satisfaction, post-procedural complications, and other outcomes. Results: WAC significantly attenuated procedure-related pain, discomfort, and intolerance, compared with AIC. Rates of cecal intubation during WAC and AIC were 100% and 94.2%, respectively. Patients undergoing WAC made no requests for on-demand sedation. Patients given AIC displayed significant increases in heart rate and blood pressure during the procedure, but the WAC group experienced no significant alterations. The rate of postprocedural complications was higher in the AIC group than the WAC group. Conclusion: WAC is superior to conventional AIC for colonic polypectomy. WAC is highly recommended for resection of colonic polyps.