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Background and aim <p>Colonoscopic insertion remains technically challenging. While cap-assisted colonoscopy (CAC) reduces the cecal intubation time (CIT), sigmoid colon water exchange (SWE) enhances linear scope advancement. We hypothesized that combined water exchange and cap-assisted colonoscopy (SWC) would optimize the CIT and improve patient tolerance during unsedated colonoscopy.</p> Patients and methods <p>This prospective randomized controlled trial (RCT) included 200 subjects scheduled for unsedated colonoscopy at a tertiary endoscopy center in Wuhan, China. The participants were randomly assigned to receive either SWC (intervention, n=100) or CAC (control, n=100). The primary outcome was CIT (minutes). The secondary outcomes included pain scores, the polyp detection rate (PDR), bowel preparation quality (Boston Bowel Preparation Scale (BBPS)), and patient willingness to repeat the procedure.</p> Results <p>Compared with CAC, SWC significantly reduced the median CIT (5.0 [IQR 4.0–7.0] min vs. 7.0 [6.0–10.0] min; <i>P</i> &lt; 0.001). The left colon pain scores were lower with SWC (1.0 [1.0–2.0] vs. 2.0 [1.0–3.0]; <i>P</i> &lt; 0.001), and the willingness to repeat was greater (96.0% vs. 85.9%; <i>P</i> = 0.024). The PDRs (61.6% vs. 58.6%; <i>P</i> = 0.663) and BBPS scores (<i>P</i> = 0.213) were comparable. Multivariate analysis revealed that SWC, better bowel preparation, younger age, no prior abdominal surgery, and the absence of constipation were independent predictors of a shorter CIT.</p> Conclusion <p>SWC shortens the CIT, reduces discomfort, and improves patient acceptance without compromising procedural quality—advantages conducive to promoting and popularizing unsedated colonoscopy.</p> Trial registration <p>The registry titled ”Transparent cap combined water exchange enteroscopy versus transparent cap method enteroscopy in time to cecal intubation: a prospective study”was registered in the Chinese Clinical Trial Registry on 14/05/2025 (clinical trial registration number: ChiCTR2500102387).Retrospectively registered.</p>

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Combined water exchange and cap-assisted colonoscopy reduces cecal intubation time and patient discomfort in patients with unsedated colonoscopy: a randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月13日

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  • Dongchu Wang,
  • Aixiang Wang,
  • Xiangwu Ding,
  • Rong Zhou

摘要

Background and aim

Colonoscopic insertion remains technically challenging. While cap-assisted colonoscopy (CAC) reduces the cecal intubation time (CIT), sigmoid colon water exchange (SWE) enhances linear scope advancement. We hypothesized that combined water exchange and cap-assisted colonoscopy (SWC) would optimize the CIT and improve patient tolerance during unsedated colonoscopy.

Patients and methods

This prospective randomized controlled trial (RCT) included 200 subjects scheduled for unsedated colonoscopy at a tertiary endoscopy center in Wuhan, China. The participants were randomly assigned to receive either SWC (intervention, n=100) or CAC (control, n=100). The primary outcome was CIT (minutes). The secondary outcomes included pain scores, the polyp detection rate (PDR), bowel preparation quality (Boston Bowel Preparation Scale (BBPS)), and patient willingness to repeat the procedure.

Results

Compared with CAC, SWC significantly reduced the median CIT (5.0 [IQR 4.0–7.0] min vs. 7.0 [6.0–10.0] min; P < 0.001). The left colon pain scores were lower with SWC (1.0 [1.0–2.0] vs. 2.0 [1.0–3.0]; P < 0.001), and the willingness to repeat was greater (96.0% vs. 85.9%; P = 0.024). The PDRs (61.6% vs. 58.6%; P = 0.663) and BBPS scores (P = 0.213) were comparable. Multivariate analysis revealed that SWC, better bowel preparation, younger age, no prior abdominal surgery, and the absence of constipation were independent predictors of a shorter CIT.

Conclusion

SWC shortens the CIT, reduces discomfort, and improves patient acceptance without compromising procedural quality—advantages conducive to promoting and popularizing unsedated colonoscopy.

Trial registration

The registry titled ”Transparent cap combined water exchange enteroscopy versus transparent cap method enteroscopy in time to cecal intubation: a prospective study”was registered in the Chinese Clinical Trial Registry on 14/05/2025 (clinical trial registration number: ChiCTR2500102387).Retrospectively registered.