Quality Criteria in Colonoscopy Using the Water-Immersion Technique

Authors

Keywords:

adenoma; colorectal cancer; colonoscopy; quality criteria

Abstract

Introduction: Colonoscopy is the technique of choice for the prevention and detection of colorectal cancer. The water-immersion technique increases the polyp detection rate and improves the quality criteria for this procedure.

Objective: To determine the performance of certain quality criteria for colonoscopy using the water-immersion technique.

Methods: An analytical study was conducted on 200 patients who underwent colonoscopy between June 2024 and February 2025. Based on the colonoscopy technique used (conventional or water immersion), two study groups of 100 patients each were formed and randomly assigned. The variables evaluated were colonoscope insertion time, withdrawal time, number of polyps detected, and polyp detection rate. Descriptive summary statistics, the chi-square test, and Fisher’s exact test were used to compare variables. Student’s t-test was used to compare means between independent samples.

Results: Insertion time was shorter in the water-immersion colonoscopy group (57.9% vs. 42.1%) (p = 0.0003), and withdrawal time was longer (54% vs. 46%) (p = 0.0023). The water-immersion technique detected a greater number of polyps (61% vs. 40%) (p = 0.0047).

Conclusions: Water-immersion colonoscopy improves the insertion and withdrawal times of the colonoscope and detects a greater number of polyps.

Downloads

Download data is not yet available.

Author Biographies

Yunia Tusen Toledo, Centro de Investigaciones Clínicas, Departamento de Gastroenterología. La Habana, Cuba.

Especialista de 1er grado en Gastroenterología

Lissette Chao González, Centro de Investigaciones Médico Quirúrgicas, Departamento de Gastroenterología. La Habana, Cuba.

Profesora e Investigadora Titular. Especialista de 2do grado en Gastroenterología. 

Lisset Barroso Márquez, Centro de Investigaciones Médico Quirúrgicas, Departamento de Gastroenterología. La Habana, Cuba.

Profesora Titular. Dra. C. Especialista de 2do grado en Gastroenterología. 

Ludmila Martinez Leyva, Hospital Militar Central Dr. Carlos J. Finlay, Departamento de Gastroenterología. La Habana, Cuba

Profesora e Investigadora Titular. Dra. C. Máster en Procederes Diagnósticos en el Primer Nivel de Atención de Salud. Máster en Cirugía de Mínimo Acceso. Especialista de 2do grado en Gastroenterología. 

 

 

 

 

Harlim Rodríguez Rodríguez, Hospital General Docente Iván Portuondo, Departamento de Gastroenterología. San Antonio de los Baños, Artemisa, Cuba

Especialista de 1er grado en Gastroenterología

References

1. Laudanno O, Pucci B, Brayer S. Detección y vigilancia pospolipectomía de pólipos colónicos. Acta Gastroenterol Latinoam. 2022 [acceso 17/02/2026];52(1):21-35. Disponible en: https://actagastro.org/deteccion-y-vigilancia-pospolipectomia-de-polipos-colonicos

2. Abdelbary M, Hamdy S, Shehab H, ElGarh N, Menesy M, Marzaban R. Técnicas colonoscópicas para la detección de pólipos: un estudio egipcio. Revista de Gastroenterología de México. 2021;86(1):36-43. DOI: https://doi.org/10.1016/j.rgmx.2020.02.004

3.Tusen Y, Chao L, Barroso L, Martínez L, Pérez T, Rodríguez H. Colonoscopia con el método de inmersión en agua en el cribado del cáncer colorrectal. Rev cuba med mil. 2023 [acceso 17/02/2026];52(2):e02302330. Disponible en: https://revmedmilitar.sld.cu/index.php/mil/article/view/2330

4. Jiao, TX, Hu Y, Guo SB. Clinical value of sigmoid colon water exchange colonoscopy: a prospective randomized clinical trial. Scientific Reports. 2023;13:13704. DOI: https://doi.org/10.1038/s41598-023-40706-4

5. Arnaert S, Persyn D, Cool M, Lambrecht G, Deboever G. Unsedated or On-Demand Minimally Sedated Water-Aided Outpatient Colonoscopy in Colorectal Cancer Screening and Surveillance: A Step Forward or Backward? Experience from Daily Practice in a Regional (Nonacademic) Hospital. Diagnostics. 2024 14(22):2596. DOI: https://doi.org/10.3390/diagnostics14222596

6. Chatoor K, Cooke F, Devane L, George P. AB005. SOH24AB_207. Water immersion technique for colonoscopy: a video vignette. Mesentery Peritoneum. 2024;8:AB005. DOI: https://doi.org/10.21037/map-24-ab005

7. Cheng CL, Tang JH, Hsieh YH, Kuo YL, Fang KCH, Tseng CHW, et al. Comparing Right-Sided Colon Adenoma and Serrated Polyp Miss Rates with Water Exchange and CO2 Insufflation: A Randomized Controlled Trial. The American Journal of Gastroenterology. 2025;120(7):1615-23. DOI: https://doi.org/10.14309/ajg.0000000000003168

8. Wang D, Wang A, Ding X, Zhou R. Combined water exchange and cap-assisted colonoscopy reduces cecal intubation time and patient discomfort in patients with unsedated colonoscopy: a randomized controlled trial. BMC Gastroenterol. 2025;26(1):42. DOI: https://doi.org/10.1186/s12876-025-04557-9

9. Moreira DV, Arias VA, Chediak E, Ayala V. Tasa de detección de adenomas y pólipos: Indicadores de calidad colonoscópica en el Hospital Metropolitano. Metro Ciencia 2023 [acceso: 17/02/2026];31(2):41-8. Disponible en: https://www.revistametrociencia.com.ec/index.php/revista/article/view/530

10. Rex DK, Anderson JC, Butterly LF, Day LW, Dominitz JA, Kaltenbach T, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2024;100(3):352-81. DOI: https://doi.org/10.1016/j.gie.2024.04.2905

11. Keswani RN, Crockett SD, Calderwood AH. AGA clinical practice update on strategies to improve quality of screening and surveillance colonoscopy: expert review. Gastroenterology. 2021;161(2):701-11. DOI: https://doi.org/10.1053/j.gastro.2021.05.041

12. Kastenberg D, Bertiger G, Brogadir S. Bowel preparation quality scales for colonoscopy. World J Gastroenterol. 2018;24(26):2833-43. DOI: https://doi.org/10.3748/wjg.v24.i26.2833

13. Estrada JG, Pastrana CM, Izquierdo M, Alonso J, Jauregui U. Caracterización clínica, endoscópica e histológica del cáncer colorrectal en un grupo de pacientes cubanos. cysa. 2020 [acceso 13/06/2026];4(3):43-52. Disponible en: https://revistas.intec.edu.do/index.php/cisa/article/view/1920

14. Asociación Médica Mundial AMM. Declaración de Helsinki de la AMM - Principios éticos para las investigaciones médicas en seres humanos. 75ª Asamblea General Helsinki; 2024 octubre. Finlandia: Asociación Médica Mundial (AMM); 2024 [acceso 17/02/2026]. Disponible en: http://www.wma.net/es/30publications/10policies/b3/

15. Alfaro A, Antonio M, Chávez MA, Cerna J. Colonoscopia de intercambio mínimo de agua y su impacto en el índice de detección de pólipos: estudio aleatorizado. Endoscopia. 2019;31(2):260-6. DOI: https://doi.org/10.24875/END.M19000106

16. Haitao S, Hong Z, Mei W, Jiong J, Sumei S, Fenrong Ch, et al. Effectiveness of Water-Assisted Colonoscopy without Sedation in Patients with Ulcerative Colitis. Dig Dis. 2023;41(5):737-45. DOI: https://doi.org/10.1159/000531652

17. Santodomingo C, Zuramay C. Eficacia de la colonoscopia con la técnica de inmersión de agua comparada con la técnica de colonoscopia convencional Endoscopia. 2014;26(2). DOI: https://doi.org/10.1016/j.endomx.2013.10.002

18. Desai M, Rex DK, Bohm ME, Davitkov P, DeWitt JM, Fischer M, et al. Impact of withdrawal time on adenoma detection rate: results from a prospective multicenter trial. Gastrointest Endosc. 2023;97(3):537-43.e2. DOI: https://doi.org/10.1016/j.gie.2022.09.031

19. Fu L, Ying H, Han Y, Jin L, Wen D, Yu H, et al. Impact of withdrawal time on the adenoma detection rate in elderly patients during unseated colonoscopy: a retrospective multicenter study. BMC Gastroenterol. 2025;25:660. DOI: https://doi.org/10.1186/s12876-025-04257-4

20. Tusen Y, Chao L, Barroso L. Criterios de calidad en la colonoscopia con el método de agua. Invest Medicoquir. 2014 [acceso 16/02/2026];6(1):70-80. Disponible en: http://www.revcimeq.sld.cu/index.php/imq/article/view/268

21. Fuccio L, Frazzoni L, Hassan C, La Marca M, Paci V, Smania V, et al. Water exchange colonoscopy increases adenoma detection rate: A systematic review with network meta-analysis of randomized controlled studies. Gastrointest Endosc. 2018;88(4):589-97. DOI: https://doi.org/10.1016/j.gie.2018.06.028

22. Scalvini D, Agazzi S, Maimaris S, Rovedatti L, Brinch D, Cappellini A, et al. Strategies to Enhance the Adenoma Detection Rate (ADR) and the Serrated Polyp Detection Rate (SPDR) in Colonoscopy: A Comprehensive Review. Gastroenterology Insights. 2025;16(1):9. DOI: https://doi.org/10.3390/gastroent16010009

23. Niu S, Yang Y, Shang G, Chen Y, Ma Z, Wu F, et al. Comparison of water immersion versus air insufflation colonoscopy under various bowel preparation conditions. Turk J Gastroenterol. 2021;32(2):209-17. DOI: https://doi.org/10.5152/tjg.2021.20162

Published

2026-09-20

How to Cite

1.
Tusen Toledo Y, Chao González L, Barroso Márquez L, Gil Llanes I, Martinez Leyva L, Rodríguez Rodríguez H. Quality Criteria in Colonoscopy Using the Water-Immersion Technique. Rev. Cub. Cir. [Internet]. 2026 Sep. 20 [cited 2026 Sep. 22];65. Available from: https://revcirugia.sld.cu/index.php/cir/article/view/1858

Issue

Section

Artículos originales