Colonoscope Insertion: Is the Future Underwater

Consequently, colonoscopy is performed under conscious or deep sedation in many countries, regardless of procedure risk, with considerable increases in institutional and social health expenditures, e.g., nursing staff and space for recovery, patient burdens of escort requirement, onsite recovery time after sedation and lost time until returning to routine activities, and increased risks of sedation complications [3]. It would be more rational to improve colonoscopy techniques to avoid generating pain than be compelled to suppress it. As pain is often a result of luminal distention and loop formation, the avoidance of either factor may improve patient comfort. Infusion of water to distend the lumen during the insertion phase eliminates many undesired consequences of gas insufflation, particularly when water is infused in an airless lumen. The colon is not elongated and the sigmoid is straightened, allowing an easier passage into the descending colon; bends and flexures are smoother and easier to negotiate, making the procedure easier and less painful. Moreover, the weight effect of water appears to prevent loop formation at the sigmoid colon [2]. As such, this technique has been used successfully in cases of previously failed cecal intubation. Into this background comes the article by Azevedo et al. [4]. The study correctly distinguishes between two dif