P134 Water-assisted colonoscopy practice in the UK: a national survey

Introduction

Colonoscopy practice has evolved over time with an increasing emphasis on the use of water to assist colonoscope insertion. This has been facilitated by the availability of the water foot pump. There is evidence to show water-assisted colonoscope insertion has lower pain scores and higher adenoma and polyp detection rates. The extent to which water-assisted colonoscopy has entered clinical practice is unclear and this study aims to evaluate this.

Methods

An online survey was prepared to evaluate colonoscopy experience and extent of water-assisted colonoscopy practice. This comprised of a series of multiple-choice questions and a free text question about issues relating to water-assisted colonoscopy. This was circulated, after approval, to Endoscopy Section members of the BSG via email in October and November 2021.

Results

107 responses were received. 78.5% of respondents had performed >1000 colonoscopies which were carried out in district general hospital (50.5%), teaching/specialist hospital (47.7%) and other (1.8%) settings. 57.0% (61/107) of endoscopists use water to assist colonoscopy insertion in most colonoscopies with 31.8% (34/107) using it occasionally and was rarely or never used by 11.2% (12/107). Only 63.6% (68/107) had formal training (4.4% course, 36.8% individual tuition, 58.8% other). 80.6% (83/103) used sterile water with the remainder using tap water. For colonoscope insertion, rectum to splenic flexure, 48.6% (52/107) use a combination of CO₂ and water, 24.3% (26/107) use water only, 22.4% (24/107) use CO₂ only and 4.7% (5/107) use other techniques. From splenic flexure to caecum, 57.0% (61/107) use CO₂ only, 36.4% (39/107) use a combination of CO₂ and water, and 6.5% (7/107) use other techniques. 66.4% (71/107) felt water-assisted colonoscopy provided greater patient comfort and 46.7% (50/107) felt it lowered insertion time. 69.2% (74/107) reported issues when using water-assisted colonoscopy including lack of experience, limitations of poor bowel preparation, mucus in left colon, and increased withdrawal time.

Conclusions

The majority of respondents to this national survey used water to assist colonoscope insertion particularly from rectum to splenic flexure where it was used exclusively or in combination with CO₂. However, a significant proportion (39/107, 36.4%) have not had formal training. Most endoscopists feel water-assisted colonoscopy provided greater patient comfort. Common issues highlighted were limitations with poor bowel preparation, mucus occurrence in the left colon and an increased withdrawal time.