RT Journal Article
SR Electronic
T1 WASh multicentre randomised controlled trial: water-assisted sigmoidoscopy in English NHS bowel scope screening
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 845
OP 852
DO 10.1136/gutjnl-2020-321918
VO 70
IS 5
A1 Matthew D Rutter
A1 Rachel Evans
A1 Zoe Hoare
A1 Christian Von Wagner
A1 Jill Deane
A1 Shiran Esmaily
A1 Tony Larkin
A1 Rhiannon Edwards
A1 Seow Tien Yeo
A1 Llinos Haf Spencer
A1 Emily Holmes
A1 Brian P Saunders
A1 Colin J Rees
A1 Zacharias P Tsiamoulos
A1 Iosif Beintaris
A1 ,
YR 2021
UL http://gut.bmj.com/content/70/5/845.abstract
AB Objectives The English Bowel Cancer Screening Programme invites 55 year olds for a sigmoidoscopy (Bowel Scope Screening (BSS)), aiming to resect premalignant polyps, thus reducing cancer incidence. A national patient survey indicated higher procedural pain than anticipated, potentially impacting on screening compliance and effectiveness. We aimed to assess whether water-assisted sigmoidoscopy (WAS), as opposed to standard CO2 technique, improved procedural pain and detection of adenomatous polyps.Design The WASh (Water-Assisted Sigmoidoscopy) trial was a multicentre, single-blind, randomised control trial for people undergoing BSS. Participants were randomised to either receive WAS or CO2 from five sites across England. The primary outcome measure was patient-reported moderate/severe pain, as assessed by patients on a standard Likert scale post procedure prior to discharge. The key secondary outcome was adenoma detection rate (ADR). The costs of each technique were also measured.Results 1123 participants (50% women, mean age 55) were randomised (561 WAS, 562 CO2). We found no difference in patient-reported moderate/severe pain between WAS and CO2 (14% in WAS, 15% in CO2; p=0.47). ADR was 15% in the CO2 arm and 11% in the WAS arm (p=0.03); however, it remained above the minimum national performance standard in both arms. There was no statistical difference in mean number of adenomas nor overall polyp detection rate. There was negligible cost difference between the two techniques.Conclusion In the context of enema-prepared unsedated screening sigmoidoscopies performed by screening-accredited endoscopists, no difference in patient-reported pain was seen when using either a CO2 or WAS intubation technique.Trial registration number ISRCTN81466870.Data are available upon reasonable request. All data relevant to the study is included in the article or can be made available upon reasonable request.