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To WE, or not to WE, that is the question
  1. Felix W Leung1,2,
  2. Joseph W Leung3,4
  1. 1 Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  2. 2 Medicine, Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, North Hills, California, USA
  3. 3 Gastroenterology, Davis Medical Center, University of California, Sacramento, California, USA
  4. 4 Medicine, Sacramento VAMC, VA Northern California Health Care Systems, Mather, California, USA
  1. Correspondence to Professor Felix W Leung, Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA; felix.leung{at}

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We read with interest the work by Rutter et al 1 who reported that ‘in enema-prepared unsedated screening sigmoidoscopies performed by screening-accredited endoscopists, no difference in patient-reported pain was seen when using either a carbon dioxide (CO2) or water-assisted sigmoidoscopy (WAS) intubation technique’. An elegant advancement of the understanding of the limitations of water assistance, the results with the endoscopist-centred WAS technique support the recommendations of ‘no need for screening sigmoidoscopists to switch to a WAS technique, nor should national policy be amended. Caution should be given to monitoring adenoma detection rate (ADR) if WAS is used in enema-prepared sigmoidoscopies’.1 These recommendations, however, do not preclude other patient-centred water-aided technique(s) to be evaluated in further studies.

The distinction between endoscopist-centred water immersion and patient-centred water exchange was explained in a related editorial.2 WAS was akin to …

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  • Contributors FWL initiated the project, and JWL provided critique and editing.

  • Funding Supported in part by VA Merit Review, and ASGE Clinical Research Funds.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.