Training residents in underwater colonoscopies is more effective than in air colonoscopies

Background Colonoscopy screenings are the most valuable tool in preventing colorectal mortalities. The traditional technique uses air-insufflation, but water-infusion is a newer colonoscopy technique which is rapidly becoming standard of care, as it may decrease patient discomfort and the need for analgesics and anesthetics. Research is still ongoing as to the comparability of detection rates between the two techniques. The purpose of this study was to determine if training residents in underwater colonoscopies is more effective than training them in traditional air-insufflation colonoscopies. Methods This study was a retrospective, single-institution study that compared the patient-related and procedure-related variables of 183 colonoscopies performed by two cohorts of physicians. In the first cohort, the gastroenterologist with a resident trainee performed an air colonoscopy. In the second, the gastroenterologist and resident trainee performed an underwater colonoscopy. Results For patient-related variables, there was no significant difference in age, previous abdominal surgeries, or bowel preparation. There were more females in the underwater group, which is significant as females tend to be harder to scope due to the increased tortuosity of their colon. For procedural outcomes, there was no significant difference in adenoma detection rate, cecal intubation rate, or procedural complications (hypotension, bradycardia). On average, the water colonoscopies required less midazolam and fentanyl, although they did have a longer procedural time. Conclusions Overall, these findings suggest that training residents in underwater colonoscopies may increase patient comfort and decrease complications with comparable success rates.