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

Sergio Cadoni; Sauid Ishaq; Cesare Hassan; P. emysl 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
, P. emysl 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

^*Corresponding author for this work

ATS Sardegna - ASSL Carbonia
Birmingham City University
Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
Palacky University—University Hospital Olomouc
Charles University
Oncologia ed Ematologia Pediatrica “Lalla Seràgnoli” Ospedale Sant'Orsola Malpighi Università di Bologna
Royal College of Physicians
University of California at Davis
Gloucestershire Hospitals NHS Foundation Trust
California Pacific Medical Center
Valduce Hospital
North Tees and Hartlepool NHS Foundation Trust
Medical School
Keio University
Roehampton University
Portsmouth Hospitals University NHS Trust
University of Florida
University of Minnesota Twin Cities
University of Virginia
Lund University
University Medical Centre Mainz
Mayo Clinic Scottsdale-Phoenix, Arizona
VU Vrije Universiteit
Hospital Virgen del Camino
Chiba University
University of British Columbia
Université Paris 5
Gadjah Mada University
Stanford University
Sheffield Teaching Hospitals NHS Foundation Trust
Department of Veterans Affairs
David Geffen School of Medicine at UCLA
Cardiff University
Department of Gastroenterology, New Tokyo Hospital, Gastroenterology, Matsudo, Chiba, Japan
Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan
King's College Hospital NHS Foundation Trust
National Hospital Organization, Japan
Hospital Universitario La Fe
NHO Kurihama Medical and Addiction Center, Endoscopy Center, Yokosuka, Japan
Newcastle upon Tyne Hospitals NHS Foundation Trust
Telemark Hospital
Xijing Hospital, Department of Gastroenterology, Xian, Republic of China
Nottingham University Hospitals NHS Trust
Wye Valley NHS Trust
Hospital Universitario 12 de Octubre
Bezmialem Vakif University
St Mark's Hospital
Centro Medico Teknon
Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan

Research output: Contribution to journal › Article › Academic › 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
Pages (from-to)	1411-1420.e18
Journal	Gastrointestinal endoscopy
Volume	93
Issue number	6
Early online date	2021
DOIs	https://doi.org/10.1016/j.gie.2020.10.011
Publication status	Published - Jun 2021

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10.1016/j.gie.2020.10.011

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Cadoni, S., Ishaq, S., Hassan, C., Falt, P. E., 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

@article{cab005459d4c423f918a448a75227528,

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 Falt, \{P. emysl\} 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 Hey-Long Ching and Hartley Cohen and Sunil Dolwani and Shai Friedland and Hideaki Harada and Yu-Hsi Hsieh 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 Chih-Wei Tseng and Hugo Uchima and Noriya Uedo and Leung, \{Felix W.\}",

note = "Funding Information: DISCLOSURE: The following author received research support for this study in part from the American Society for Gastrointestinal Endoscopy and VA Clinical Merit Research Grants: F. W. Leung. In addition, the following authors disclosed financial relationships: S. Ishaq, N. Suzuki: Consultant for Olympus. C. Hassan: Consultant for Fujifilm, Pentax, and Medtronic. J. W. Leung: Equipment loan and investigator for Olympus. P. Bhandari: Research support and honorarium from Fujifilm, Olympus, and Pentax. P. V. Draganov: Consultant for Olympus, Cook, BSC, Medtronic, MicroTech, Fuji, and Lumendi. H. Neumann: Consultant for Boston Scientific, Norgine, SonoScape, Motus GI, Medtronic, Amgen, Jinshan, and Falk. S. Dolwani: Researcher for Odin Vision. B. Hayee: Consultant for Medtronic UK, Surgease Innovations UK, and Ampersand Ltd UK; reearch support from Fujifilm Europe. S. Olafsson: Consultant for Takeda. All other authors disclosed no financial relationships. Funding Information: DISCLOSURE: The following author received research support for this study in part from the American Society for Gastrointestinal Endoscopy and VA Clinical Merit Research Grants: F. W. Leung. In addition, the following authors disclosed financial relationships: S. Ishaq, N. Suzuki: Consultant for Olympus. C. Hassan: Consultant for Fujifilm, Pentax, and Medtronic. J. W. Leung: Equipment loan and investigator for Olympus. P. Bhandari: Research support and honorarium from Fujifilm, Olympus, and Pentax. P. V. Draganov: Consultant for Olympus, Cook, BSC, Medtronic, MicroTech, Fuji, and Lumendi. H. Neumann: Consultant for Boston Scientific, Norgine, SonoScape, Motus GI, Medtronic, Amgen, Jinshan, and Falk. S. Dolwani: Researcher for Odin Vision. B. Hayee: Consultant for Medtronic UK, Surgease Innovations UK, and Ampersand Ltd UK; reearch support from Fujifilm Europe. S. Olafsson: Consultant for Takeda. All other authors disclosed no financial relationships. Publisher Copyright: {\textcopyright} 2021 American Society for Gastrointestinal Endoscopy Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = jun,

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

language = "English",

volume = "93",

pages = "1411--1420.e18",

journal = "Gastrointestinal endoscopy",

issn = "0016-5107",

publisher = "Mosby Inc.",

number = "6",

}

Cadoni, S, Ishaq, S, Hassan, C, Falt, PE, 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, H-L, Cohen, H, Dolwani, S, Friedland, S, Harada, H, Hsieh, Y-H, 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, C-W, 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

TY - JOUR

T1 - Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations

AU - Cadoni, Sergio

AU - Ishaq, Sauid

AU - Hassan, Cesare

AU - Falt, P. emysl

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.

N1 - Funding Information: DISCLOSURE: The following author received research support for this study in part from the American Society for Gastrointestinal Endoscopy and VA Clinical Merit Research Grants: F. W. Leung. In addition, the following authors disclosed financial relationships: S. Ishaq, N. Suzuki: Consultant for Olympus. C. Hassan: Consultant for Fujifilm, Pentax, and Medtronic. J. W. Leung: Equipment loan and investigator for Olympus. P. Bhandari: Research support and honorarium from Fujifilm, Olympus, and Pentax. P. V. Draganov: Consultant for Olympus, Cook, BSC, Medtronic, MicroTech, Fuji, and Lumendi. H. Neumann: Consultant for Boston Scientific, Norgine, SonoScape, Motus GI, Medtronic, Amgen, Jinshan, and Falk. S. Dolwani: Researcher for Odin Vision. B. Hayee: Consultant for Medtronic UK, Surgease Innovations UK, and Ampersand Ltd UK; reearch support from Fujifilm Europe. S. Olafsson: Consultant for Takeda. All other authors disclosed no financial relationships. Funding Information: DISCLOSURE: The following author received research support for this study in part from the American Society for Gastrointestinal Endoscopy and VA Clinical Merit Research Grants: F. W. Leung. In addition, the following authors disclosed financial relationships: S. Ishaq, N. Suzuki: Consultant for Olympus. C. Hassan: Consultant for Fujifilm, Pentax, and Medtronic. J. W. Leung: Equipment loan and investigator for Olympus. P. Bhandari: Research support and honorarium from Fujifilm, Olympus, and Pentax. P. V. Draganov: Consultant for Olympus, Cook, BSC, Medtronic, MicroTech, Fuji, and Lumendi. H. Neumann: Consultant for Boston Scientific, Norgine, SonoScape, Motus GI, Medtronic, Amgen, Jinshan, and Falk. S. Dolwani: Researcher for Odin Vision. B. Hayee: Consultant for Medtronic UK, Surgease Innovations UK, and Ampersand Ltd UK; reearch support from Fujifilm Europe. S. Olafsson: Consultant for Takeda. All other authors disclosed no financial relationships. Publisher Copyright: © 2021 American Society for Gastrointestinal Endoscopy Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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.

UR - https://www.scopus.com/pages/publications/85099123178

UR - https://www.ncbi.nlm.nih.gov/pubmed/33069706

U2 - 10.1016/j.gie.2020.10.011

DO - 10.1016/j.gie.2020.10.011

M3 - Article

C2 - 33069706

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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