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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 …
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.
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