Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations

Sergio Cadoni; Sauid Ishaq; Cesare Hassan; Přemysl Falt; Lorenzo Fuccio; Keith Siau; Joseph W. Leung; John Anderson; Kenneth F. Binmoeller; Franco Radaelli; Matt D. Rutter; Shinya Sugimoto; Humayun Muhammad; Pradeep Bhandari; Peter V. Draganov; Piet de Groen; Andrew Y. Wang; Andrew W. Yen; Chris Hamerski; Henrik Thorlacius; Helmut Neumann; Francisco Ramirez; Chris J.J. Mulder; Eduardo Albéniz; Arnaldo Amato; Makoto Arai; Adrian Bak; Maximilien Barret; Putut Bayupurnama; Ramsey Cheung; Hey Long Ching; Hartley Cohen; Sunil Dolwani; Shai Friedland; Hideaki Harada; Yu Hsi Hsieh; Bu Hayee; Toshio Kuwai; Vicente Lorenzo-Zúñiga; Mauro Liggi; Takeshi Mizukami; Donatella Mura; David Nylander; Snorri Olafsson; Silvia Paggi; Yanglin Pan; Adolfo Parra-Blanco; Rupert Ransford; Joaquìn Rodriguez-Sanchez; Hakan Senturk; Noriko Suzuki; Chih Wei Tseng; Hugo Uchima; Noriya Uedo; Felix W. Leung

doi:10.1016/j.gie.2020.10.011

Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations

Sergio Cadoni, Sauid Ishaq, Cesare Hassan, Přemysl Falt, Lorenzo Fuccio, Keith Siau, Joseph W. Leung, John Anderson, Kenneth F. Binmoeller, Franco Radaelli, Matt D. Rutter, Shinya Sugimoto, Humayun Muhammad, Pradeep Bhandari, Peter V. Draganov, Piet de Groen, Andrew Y. Wang, Andrew W. Yen, Chris Hamerski, Henrik ThorlaciusHelmut Neumann, Francisco Ramirez, Chris J.J. Mulder, Eduardo Albéniz, Arnaldo Amato, Makoto Arai, Adrian Bak, Maximilien Barret, Putut Bayupurnama, Ramsey Cheung, Hey Long Ching, Hartley Cohen, Sunil Dolwani, Shai Friedland, Hideaki Harada, Yu Hsi Hsieh, Bu Hayee, Toshio Kuwai, Vicente Lorenzo-Zúñiga, Mauro Liggi, Takeshi Mizukami, Donatella Mura, David Nylander, Snorri Olafsson, Silvia Paggi, Yanglin Pan, Adolfo Parra-Blanco, Rupert Ransford, Joaquìn Rodriguez-Sanchez, Hakan Senturk, Noriko Suzuki, Chih Wei Tseng, Hugo Uchima, Noriya Uedo, Felix W. Leung

Research output: Contribution to journal › Article › peer-review

Abstract

Background and Aims: Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. Methods: Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. Results: In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). Conclusions: The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.

Original language	English (US)
Pages (from-to)	1411-1420.e18
Journal	Gastrointestinal endoscopy
Volume	93
Issue number	6
DOIs	https://doi.org/10.1016/j.gie.2020.10.011
State	Published - Jun 2021

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Gastroenterology

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10.1016/j.gie.2020.10.011

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Cadoni, S., Ishaq, S., Hassan, C., Falt, P., Fuccio, L., Siau, K., Leung, J. W., Anderson, J., Binmoeller, K. F., Radaelli, F., Rutter, M. D., Sugimoto, S., Muhammad, H., Bhandari, P., Draganov, P. V., de Groen, P., Wang, A. Y., Yen, A. W., Hamerski, C., ... Leung, F. W. (2021). Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations. Gastrointestinal endoscopy, 93(6), 1411-1420.e18. https://doi.org/10.1016/j.gie.2020.10.011

Cadoni, S, Ishaq, S, Hassan, C, Falt, P, Fuccio, L, Siau, K, Leung, JW, Anderson, J, Binmoeller, KF, Radaelli, F, Rutter, MD, Sugimoto, S, Muhammad, H, Bhandari, P, Draganov, PV, de Groen, P, Wang, AY, Yen, AW, Hamerski, C, Thorlacius, H, Neumann, H, Ramirez, F, Mulder, CJJ, Albéniz, E, Amato, A, Arai, M, Bak, A, Barret, M, Bayupurnama, P, Cheung, R, Ching, HL, Cohen, H, Dolwani, S, Friedland, S, Harada, H, Hsieh, YH, Hayee, B, Kuwai, T, Lorenzo-Zúñiga, V, Liggi, M, Mizukami, T, Mura, D, Nylander, D, Olafsson, S, Paggi, S, Pan, Y, Parra-Blanco, A, Ransford, R, Rodriguez-Sanchez, J, Senturk, H, Suzuki, N, Tseng, CW, Uchima, H, Uedo, N & Leung, FW 2021, 'Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations', Gastrointestinal endoscopy, vol. 93, no. 6, pp. 1411-1420.e18. https://doi.org/10.1016/j.gie.2020.10.011

@article{0bd4c14d017b470ea81710172310fc56,

title = "Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations",

abstract = "Background and Aims: Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. Methods: Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. Results: In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). Conclusions: The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.",

author = "Sergio Cadoni and Sauid Ishaq and Cesare Hassan and P{\v r}emysl Falt and Lorenzo Fuccio and Keith Siau and Leung, {Joseph W.} and John Anderson and Binmoeller, {Kenneth F.} and Franco Radaelli and Rutter, {Matt D.} and Shinya Sugimoto and Humayun Muhammad and Pradeep Bhandari and Draganov, {Peter V.} and {de Groen}, Piet and Wang, {Andrew Y.} and Yen, {Andrew W.} and Chris Hamerski and Henrik Thorlacius and Helmut Neumann and Francisco Ramirez and Mulder, {Chris J.J.} and Eduardo Alb{\'e}niz and Arnaldo Amato and Makoto Arai and Adrian Bak and Maximilien Barret and Putut Bayupurnama and Ramsey Cheung and Ching, {Hey Long} and Hartley Cohen and Sunil Dolwani and Shai Friedland and Hideaki Harada and Hsieh, {Yu Hsi} and Bu Hayee and Toshio Kuwai and Vicente Lorenzo-Z{\'u}{\~n}iga and Mauro Liggi and Takeshi Mizukami and Donatella Mura and David Nylander and Snorri Olafsson and Silvia Paggi and Yanglin Pan and Adolfo Parra-Blanco and Rupert Ransford and Joaqu{\`i}n Rodriguez-Sanchez and Hakan Senturk and Noriko Suzuki and Tseng, {Chih Wei} and Hugo Uchima and Noriya Uedo and Leung, {Felix W.}",

note = "Publisher Copyright: {\textcopyright} 2021 American Society for Gastrointestinal Endoscopy",

year = "2021",

month = jun,

doi = "10.1016/j.gie.2020.10.011",

language = "English (US)",

volume = "93",

pages = "1411--1420.e18",

journal = "Gastrointestinal endoscopy",

issn = "0016-5107",

publisher = "Mosby Inc.",

number = "6",

}

TY - JOUR

T1 - Water-assisted colonoscopy

T2 - an international modified Delphi review on definitions and practice recommendations

AU - Cadoni, Sergio

AU - Ishaq, Sauid

AU - Hassan, Cesare

AU - Falt, Přemysl

AU - Fuccio, Lorenzo

AU - Siau, Keith

AU - Leung, Joseph W.

AU - Anderson, John

AU - Binmoeller, Kenneth F.

AU - Radaelli, Franco

AU - Rutter, Matt D.

AU - Sugimoto, Shinya

AU - Muhammad, Humayun

AU - Bhandari, Pradeep

AU - Draganov, Peter V.

AU - de Groen, Piet

AU - Wang, Andrew Y.

AU - Yen, Andrew W.

AU - Hamerski, Chris

AU - Thorlacius, Henrik

AU - Neumann, Helmut

AU - Ramirez, Francisco

AU - Mulder, Chris J.J.

AU - Albéniz, Eduardo

AU - Amato, Arnaldo

AU - Arai, Makoto

AU - Bak, Adrian

AU - Barret, Maximilien

AU - Bayupurnama, Putut

AU - Cheung, Ramsey

AU - Ching, Hey Long

AU - Cohen, Hartley

AU - Dolwani, Sunil

AU - Friedland, Shai

AU - Harada, Hideaki

AU - Hsieh, Yu Hsi

AU - Hayee, Bu

AU - Kuwai, Toshio

AU - Lorenzo-Zúñiga, Vicente

AU - Liggi, Mauro

AU - Mizukami, Takeshi

AU - Mura, Donatella

AU - Nylander, David

AU - Olafsson, Snorri

AU - Paggi, Silvia

AU - Pan, Yanglin

AU - Parra-Blanco, Adolfo

AU - Ransford, Rupert

AU - Rodriguez-Sanchez, Joaquìn

AU - Senturk, Hakan

AU - Suzuki, Noriko

AU - Tseng, Chih Wei

AU - Uchima, Hugo

AU - Uedo, Noriya

AU - Leung, Felix W.

PY - 2021/6

Y1 - 2021/6

N2 - Background and Aims: Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. Methods: Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. Results: In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). Conclusions: The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.

AB - Background and Aims: Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. Methods: Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. Results: In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). Conclusions: The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.

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DO - 10.1016/j.gie.2020.10.011

M3 - Article

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AN - SCOPUS:85099123178

SN - 0016-5107

VL - 93

SP - 1411-1420.e18

JO - Gastrointestinal endoscopy

JF - Gastrointestinal endoscopy

IS - 6

ER -

Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations

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