Water-aided techniques improve serrated polyp detection rate

Water-aided techniques (WT), particularly the water exchange (WE) method, help enhance serrated polyp detection rate (SPDR) during colonoscopy, a study has shown.

“This technique should be encouraged in a clinical setting to detect these polyps to prevent interval colorectal cancer,” the authors said.

This systematic review and meta-analysis of studies comparing WT with the standard gas-assisted (GA) method sought to determine any impact on SPDR and sessile SPDR. The databases of Medline, Embase, Cochrane Library, Cinahl, and Web of Sciences were searched for randomized controlled trials (RCTs).

SPDR was the primary outcome, and secondary ones included sessile SPDR and cecal intubation rate. The authors calculated risk ratios (RRs) for each outcome and considered a p-value of <0.05 to be statistically significant.

Four RCTs with five arms and a total of 5,306 patients (2,571 in the GA group and 2,735 in the WT group) met the eligibility criteria.

SPDR was substantially higher in the WT group than in the GA group (6.1 percent vs 3.8 percent; RR, 1.63, 95 percent confidence interval [CI], 1.24–2.13; p<0.001; I², 22.7 percent). In a subgroup analysis for the WE method, SPDR also improved as compared with that in the GA method (4.9 percent vs 3.2 percent; RR, 1.57, 95 percent CI, 1.15–2.14; p=0.004; I², 6.1 percent).

“The utility of WT (eg, WE and water immersion) have been studied extensively in the literature for improving colonoscopy outcome metrics such as adenoma detection rate,” the authors said. “Serrated polyps owing to their location and appearance have a high miss rate.”