Water exchange (WE) is a relatively new method of endoscope insertion during colonoscopy. Although its origin is rooted in the insertion phase of colonoscopy, allowing the procedure to proceed with more ease, less discomfort, and less or no sedation, its most important value may reside in the withdrawal phase. In this issue, a randomized, prospective study from China specifically designed to examine the effect of WE on adenoma detection rate (ADR) confirms previous findings: WE improves ADR. Here we discuss the trial results, the benefits of WE, and the challenges that may preclude or delay widespread WE implementation.
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