Is water exchange superior to water immersion in detecting adenomas during colonoscopies? Results from a Bayesian network meta-analysis

Xin Shi, Dan Tian, Xiaofei Ye, Qiong Wu, Yanglin Pan, Zhiping Yang _ and Daiming Fan

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Oncotarget. 2018; 9:30679-30693. https://doi.org/10.18632/oncotarget.25504

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Xin Shi1,*, Dan Tian2,*, Xiaofei Ye3,*, Qiong Wu1, Yanglin Pan1, Zhiping Yang1 and Daiming Fan1

1State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China

2Office of Educational Administration, Fourth Military Medical University, Xi’an, China

3Department of Health Statistics, Second Military Medical University, Shanghai, China

*These authors contributed equally to this work

Correspondence to:

Zhiping Yang, email: [email protected]

Yanglin Pan, email: [email protected]

Keywords: colonoscopy; water exchange; water immersion; colorectal adenoma; network meta-analysis

Received: February 14, 2018     Accepted: May 08, 2018     Published: July 17, 2018


Aim: Water-assisted colonoscopy (water exchange [WE] and water immersion [WI]) has been shown to improve the adenoma detection rate. However, few studies have compared these two methods head-to-head. Thus, we conducted a network meta-analysis to integrate both direct and indirect evidence comparing the effectiveness of these two procedures.

Method: We searched PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for original papers and abstracts published up to March 2018. Randomized controlled trials (RCTs) reporting data in accordance with the eligibility criteria were included in this study. We performed a Bayesian random effects network meta-analysis with mixed comparisons.

Results: Twenty-nine studies (n = 11464 patients) including 6 direct and 23 indirect comparisons were included in this network meta-analysis. There was a statistically significant difference in the efficacy of adenoma detection when WE was compared with WI (risk ratio [RR]: 1.2, 95% credible interval [CrI]: 1.1–1.3), air insufflation (AI; RR: 1.3, 95% CrI: 1.1–1.4), and carbon dioxide (CO2) insufflation (RR: 1.2, 95% CrI: 1.1–1.5). The different methods were ranked in order from the most to least effective in adenoma detection as follows: WE, WI, AI, and CO2. Moreover, although there were no significant differences in pain scores, willingness to repeat, caecal intubation rate, or total procedure time between WI and WE colonoscopy, WE required a longer caecal intubation time than WI.

Conclusion: This network meta-analysis supposes that WE may be superior to WI in detecting adenomas during colonoscopies without affecting other technical features or patient acceptance.

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