The Water Method Colonoscopy in Routine Unsedated Colonoscopy Examinations
The Water Method Colonoscopy in Routine Unsedated Colonoscopy Examinations
Aim of the Study :

 This study will compare the colonoscopy examination between the air method (air insufflation)
 and water method (water infusion) in unsedated patients with indication (symptoms and signs
 based) of colonoscopy examination. This study is based on earlier study which showed that
 water method had better results in reducing abdominal pain, caecal intubation and patients
 willingness to repeat colonoscopy examination than air method.

 Background:

 Colonoscopy examination is an important method to examine and establish the diagnosis of
 various diseases in the colon. Colonoscopy is successful when the tip of the scope reach the
 cecum and observe the caecal valve and/ or appendix orifice. This examination can be
 performed unsedated or under sedation (conscious sedation or deep sedation/general
 anaesthesia). The main disadvantage of unsedated colonoscopy method is the abdominal
 discomfort or pain during examination that may make patient distress and hemodynamically
 unstable and possibly stoppage of the examination before reach the cecum, but the severity of
 abdominal symptoms is vary from patient to patient. Many efforts have been tried to reduce
 the abdominal discomfort during examination. This unsedated method with air insufflation is
 our hospital standard method for colonoscopy examination since early 1980s, and less than 1%
 of patients were colonoscopied with conscious or deep sedation. Our study showed the success
 rate of this standard unsedated method was about 82%. The advantage of this method is
 inexpensive (feasible for most of people in developing country like us), patient may be
 examined ambulatory without escort, may back to work as soon as the examination is finished.
 Studies showed that replace the air insufflation with water infusion into colon since the
 beginning of the examination increased the success rate of caecal intubation and reduced the
 abdominal pain symptoms during colonoscopy examination(1). Sedation or general anaesthesia
 may increase the success rate of colonoscopy examination but it is costly, and may increase
 the adverse event especially in the elderly or patients with significance cardiopulmonary
 problems.

 Research Design and Methods:

 Eligible patients in the hospital clinics or wards will be offered to follow unsedated
 colonoscopy examination. The principle investigator (PI) will explain the study, the
 colonoscopy procedure , the various symptoms that may be felt during examination, the
 possible adverse event and medical effort to prevent it. Patient who sign the informed
 consent will be included in the study.

 Methods on the day of exam. Enrolled patients will be sent to the endoscopy room and
 colonoscopy will be performed by the principle investigator. Patient lie on the left lateral
 position with right hip and knee flexed and left leg straight. When the PI about to start the
 single-handed colonoscopy examination, the blinded observer open the sealed envelops with the
 code enclosed. A standard colonoscope will be inserted. Patient may be ordered to change the
 position and or abdominal compression may be applied by nurse to aid the colonoscope
 advancement. Oximetry, cardiac rhythm and blood pressure will be monitored during
 examination. Blinding will not be performed in this study because of the feeling of water or
 air effect inside the colon can be differentiated by the patient so that in our opinion it
 actually can not be blinded..The control method includes usual air insufflation during
 insertion and shortening maneuvers. The study method includes only water infusion (air pump
 is turned off) through the colonoscope during insertion since the scope is inserted into the
 anus until reach the cecum. Water will be infused as needed under endoscopist judgement
 through the adaptor on biopsy channel with endoscopic washer pump. The usual air insufflation
 will be used during colonoscope withdrawal to facilitate mucosal examination and perform any
 other intervention, such as biopsy. Hypothesis testing: The unsedated colonoscopy with
 natural temperature water infusion minimize the pain symptoms than unsedated colonoscopy with
 usual air insufflation.
Inclusion Criteria:

 -  Adult > 18 years old with indication for colonoscopy, such as chronic diarrhea,
 chronic constipation, hematochezia, chronic lower abdominal pain, positive fecal
 occult blood test, and other change of bowel habit symptoms indicative for colonoscopy
 examination

 Exclusion Criteria:

 -  Patients refuse to participate

 -  Patient with obstructive lesion in the colon distal of the cecum,

 -  Patients with experienced of colon resection, hemodynamically unstable,severe cardiac
 disorders (such as acute myocardial infarction,unstable angina,malignant arrhythmia,
 and moderate to severe congestive heart failure,

 -  Patients with fecal obstruction (whatever the cause) so that impossible to pass the
 scope through the obstructed segment;

 -  Patients with communication problems.