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Editorial: Water Exchange vs. Water Immersion During Colonoscope Insertion

Rex, Douglas K MD1

American Journal of Gastroenterology: September 2014 - Volume 109 - Issue 9 - p 1401–1403
doi: 10.1038/ajg.2014.235

Abstract: Water exchange (water infusion with water removal primarily during insertion) and water immersion (water infusion with water removal during withdrawal) reduce patient discomfort during colonoscope insertion compared with air insufflation, and represent a major achievement in colonoscopy. Hsiehet al.found that water exchange, relative to water immersion, resulted in more painless insertions to the cecum and improved adenoma detection in the right colon. However, water exchange is also associated with better bowel cleansing and longer insertion and procedure times. These factors are not specific to water exchange, but could account for all or part of the better results with water exchange. Additional controlled investigation is needed to define the benefits of water exchange compared with water immersion.

1Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA

Correspondence: Douglas K. Rex, MD, Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indiana University Hospital #4100, 550 N. University Boulevard, Indianapolis, Indiana 46202, USA. E-mail:

Received 05 June 2014; accepted 01 July 2014

Guarantor of the article: Douglas K. Rex, MD.

Specific author contributions: The editorial was drafted and finalized by D. Rex.

Financial support: D. Rex is a consultant to and has received research support from Olympus America Corp. and Endochoice.

Potential competing interests: None.

© The American College of Gastroenterology 2014. All Rights Reserved.
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