SP 8.15 Water-Based Insufflation Versus Gas-Based Insufflation for Elective Colonoscopies: A Systematic Review and Meta-Analysis

Introduction

The objective of this article is to compare water-based insufflation against gas-based insufflation in patients undergoing colonoscopies.

Methods

Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find randomized, controlled trials (RCT) comparing water-based insufflation versus gas-based insufflation in colonoscopy. All data were analysed using Review Manager Software 5.4, and the meta-analysis was performed with a random effect model analysis.

Results

A total of 31 RCTs recruiting 11,563 patients undergoing colonoscopy using water-based versus gas-based insufflation were included. In the random effect model analysis, water-based insufflation was associated with a higher caecal intubation rate (Odds ratio [OR]: 1.54, 95% confidence interval [CI] [0.93, 2.54], z = 1.69, P = 0.09) and a higher caecal intubation time (Standardized mean difference [SMD]: 0.59, 95% CI [0.27, 0.91], z = 3.58, P = 0.0003).

Water-based insufflation demonstrated higher adenoma/polyp detection rates (OR: 1.23, 95% CI [1.06, 1.43], z = 2.68, P = 0.007), as well as a lower visual analogue scale (VAS) pain score (SMD: -0.77, 95% CI [-1.00, -0.53], z = 6.31, P < 0.00001),

Secondary outcomes demonstrated statistically significant lower on-demand sedation rates (P < 0.00001), lower rate of abdominal compression (P = 0.0008), a lower rate of change of position (P < 0.0001), and a higher willingness to repeat colonoscopy (P = 0.0004) in water-based colonoscopies.

Conclusion

Water based insufflation has a clinically proven advantage over gas insufflation, in terms of all important variables.