P1479 - Comparison of Colonoscopy Outcomes and Learning Experience of Water Exchange vs. Air Insufflation by Trainees

Felix Leung, MD
Sepulveda Ambulatory Care Center, VAGLAHS, North Hills, CA

Introduction: A consensus review confirmed that water exchange (WE) increased polyp and adenoma detection rate (PDR, ADR) [GIE 2021;93:1411]. With WE being new and novel, it is unknown if trainees would be able to replicate such benefits, and if they would report a more favorable experience in learning WE. The hypotheses that supervised trainees could achieve a significantly higher PDR, and they might have a more favorable evaluation of the WE training process were tested.

Methods: In a prospective manner, in consecutive sedated patients assigned to the author with a trainee present, WE and air insufflation were taught in alternating order. WE induced less pain and was used in unsedated patients. WE emphasized no air, suction of residual gas pockets, placement of the suction port in the center of the lumen to achieve near-complete removal of debris and infused water during insertion. After each supervised examination, procedural outcomes were noted. Trainee evaluation of confidence in the technical skills; and learning experience with the respective methods were scored using a 5 point scale [1 (strongly agree) to 5 (strongly disagree); lower scores were more favorable]. IRB approval was not required for de-identified educational evaluation.

Results: From 2/2016 to May/2021, trainees performed 83 air insufflation and 119 WE cases. The long air insufflation insertion time 30 (20) min suggested the trainees were inexperienced. The significantly longer WE insertion time 40 (21) min confirmed WE salvage cleaning required time. The WE group had significantly better procedural outcomes and higher PDR (54% vs. 32%, p=0.0447). Statement responses: 1. Trainees were equally confident in technical skills with both methods; WE (2.76 (0.91) and air insufflation (2.85 (0.87). 2. Training experience WE 2.02 (1.00) vs. air insufflation 2.43 (1.19), p=0.0018 was significantly better than expected for WE.

Discussion: Strength: Prospective data gathering in routine educational sessions, experienced trainer.
Weakness: Non randomized, unblinded
This modest attempt with small case numbers confirmed that supervised trainees were able to achieve significantly higher PDR during WE training, and their assessment of the learning experience was more favorable for WE. Introducing WE to trainees facilitates its dissemination in clinical practice. The significantly higher PDR is a cogent patient-centered incentive for both the trainer and the trainees. A RCT is in order.




Figure: Procedure outcome and trainee scores


Disclosures:
Felix Leung indicated no relevant financial relationships.


Felix Leung, MD. P1479 - Comparison of Colonoscopy Outcomes and Learning Experience of Water Exchange vs. Air Insufflation by Trainees, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.