August 31st, 2010
Drown out that pain! Warm water infusions lead to better colonoscopy tolerance.
Well it seems you can teach an old dog a new trick after all! About 18 months ago I was exposed to the concept of infusing warm water into the colon during the initial part of the colonoscopy exam (100-150ml injected through the biopsy port when at the recto-sigmoid junction up through the sigmoid colon) and I have become a firm believer it helps navigate these difficult turns in the sigmoid, leads to less “looping” in the colon and as a result is more comfortable for the patient and the endoscopist.
My nurses note the difference as well and now most of my colleagues and fellows we train use this technique and all universally praise the results.
So, my question to you is:
1) Do you infuse water?
2) If so, where, how (syringe, foot pedal), how much?
3) What do you think of it?
4) If no, why not?
Look forward to hearing from you!
3 Responses to “Drown out that pain! Warm water infusions lead to better colonoscopy tolerance.”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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1. Yes, we’ve started to infuse water some month ago, with increasing frequency, mainly for patients with known oder expectedly difficult sigmoid
2. We start mostly in the rectum and use a foot pedal for the injection pump (‘Endo-jet’, separate ‘jet’-channel in Olympus endoscopes), app. 100 to 150 ml cold (!) water.
3. The more we used it, the more we were convinced that it’s usefull.
Only rarely a patient remarked that he feel the cold, but far from being uncomfortable. We noticed no other adverse reactions. So my question: is it necessary to use warm water ?
The most important thing to perform a good colonoscopy is to minimize the loop formation and decrease the angle between descending colon and transverse colon; therefore, decrease of the inflated air is the key point to shorten this distance. To me, it is waste of time to infuse 100-150ml warm water into the colon. Probably, it may be helpful to open the lumen of a spastic colon but in the left decubitus position, the water will eventually go to the descending colon, which is already a straight portion fixed in the retroperitoneum.
It seems to decrease the degree of patient pain and may well decrease transit time to cecum, but my concern is that with this technique, the bowel is not distended when advancing with water infusion and some lesions may be missed relying on withdrawal to find them. Seems to me that a double look (while advancing and withdrawing) would be more efficient in picking up lesions. Sedation is excellent now, and water infusion could be limited to those situations where scope advancement is difficult.