Cool water versus warm water immersion for minimal sedation colonoscopy – a double-blind, randomized trial

Abstract

Water-aided insertion as an alternative colonoscopy technique reduces patient's discomfort during the procedure. Warm water has been used in most of the published trials. Infusion of cool water is technically less demanding and a proof of its efficacy could support the use of water-aided technique in routine practice.

Method: In a double-blind, randomized, single-centre study, a total of 201 patients were randomized to either cool water (20-24 °C) or warm water (37 °C) immersion insertion. The main outcome was a caecal intubation time.

Results: Caecal intubation time was comparable; 6.9 ± 3.5 min in cool water vs 7.0 ± 3.4 min in warm water arm (P = 0.64). Success rate of minimal sedation colonoscopy (89.1% for cool water vs 90% for warm water, P = 1.00) and discomfort during colonoscopy (P = 0.51) were not different. All other outcomes except higher need for abdominal compression in cool water arm (P = 0.04) were comparable -total procedure time, terminal ileum intubation rate, adenoma detection, length of the inserted scope, water volume, nonstandard position rate, difficulty of the procedure and patient's temperature sensation.

Conclusion: In comparison with warm water immersion, the use of cool water did not modify the caecal intubation time. Other characteristics with the exception of abdominal compression rate were not different. Cool water immersion seems to be a comparable alternative to a technically more demanding warm water immersion colonoscopy.