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Does water immersion WASH in bowel scope?
  1. Sauid Ishaq1,2,
  2. Keith Siau3,4,
  3. Sergio Cadoni5
  1. 1 Department of Gastroenterology, Dudley Group NHS Foundation Trust, Dudley, UK
  2. 2 Department of Health and Science, Birmingham City University, Birmingham, UK
  3. 3 Joint Advisory Group, Royal College of Physicians, London, UK
  4. 4 Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK
  5. 5 Digestive Endoscopy Unit, CTO Hospital, Iglesias, SU, Italy
  1. Correspondence to Professor Sauid Ishaq, Department of Gastroenterology, Dudley Group NHS Foundation Trust, Dudley DY12HQ, UK; sauid.ishaq{at}

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Rutter et al 1 should be congratulated on this first randomised controlled trial (RCT) comparing water-assisted sigmoidoscopy (WAS) versus carbon dioxide (CO2) insufflation in patients undergoing English Bowel Scope Screening (BSS). The authors reported no significant difference in the primary outcome of recalled pain, or in secondary outcomes of adenoma detection rate (ADR) between WAS and CO2 insufflation groups. Before we consider the study findings, we would like to discuss the following points with the esteemed authors of this study.

First, the WAS technique deserves mention. The authors used the water immersion (WI) technique to facilitate progression of scope with CO2 insufflation when required and the infused water was aspirated during withdrawal. The gold standard water exchange (WE) technique was not chosen for the study, which would have removed the infused water mainly during insertion …

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  • Contributors All authors contributed equally in drafting this letter.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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; externally peer reviewed.