INTRODUCTION Postcolonoscopy colorectal cancers primarily occur in the right-sided colon because of missed adenomas and serrated polyps (SPs). Water exchange (WE) improves cleanliness and visibility of the right-sided colon. We hypothesized that WE could reduce the right-sided colon adenoma (rAMR) and SP miss rate (rSPMR) compared to standard colonoscopy. METHODS We randomly assigned 386 colonoscopy patients to insertion with either WE or CO2 insufflation. During the first withdrawal, polypectomies were performed up to the hepatic flexure. A second endoscopist, blinded to the insertion technique, reexamined the right-sided colon. The miss rate was determined by dividing the number of additional adenomas or SPs by the total number detected in both examinations. The primary outcome was the combined rAMR and rSPMR. RESULTS WE significantly decreased the combined rAMR and rSPMR (22.2% vs 32.2%, P < 0.001) and rSPMR alone (22.5% vs 37.1%, P = 0.002) compared to CO2 insufflation, but not rAMR (21.8% vs 29.8%, P = 0.079). Additionally, WE significantly increased the detection of SP per colonoscopy (SPPC) in the right-sided colon (0.95 ± 1.56 vs 0.50 ± 0.79, P < 0.001). Multivariate logistic regression analysis showed that ≥2 SPs in the right-sided colon was an independent predictor of rSPMR (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.89─6.38), along with a higher right-sided colon Boston Bowel Preparation Scale score (OR, 0.55; 95% CI, 0.32─0.94). CONCLUSIONS The significant reduction in rSPMR and increase in right-sided colon SPPC suggest that colonoscopy insertion using WE is a valid alternative to CO2 insufflation (Clinical trial registration number: NCT04124393).

中文翻译：

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比较右侧结肠腺瘤和锯齿状息肉漏诊率与水交换和 CO2 吹入：一项随机对照试验。


引言 结肠镜检查后结直肠癌主要发生在右侧结肠，因为漏诊腺瘤和锯齿状息肉 （SP）。水交换 （WE） 提高了右侧结肠的清洁度和可见度。我们假设与标准结肠镜检查相比，WE 可以降低右侧结肠腺瘤 （rAMR） 和 SP 漏诊率 （rSPMR）。方法 我们将 386 例结肠镜检查患者随机分配到 WE 或 CO2 吹入组。在第一次停药期间，进行息肉切除术直至肝曲。第二名内窥镜医师对插入技术不知情，重新检查了右侧结肠。漏诊率是通过将额外腺瘤或 SP 的数量除以在两次检查中检测到的总数来确定的。主要结局是 rAMR 和 rSPMR 联合治疗。结果 与 CO2 吹入相比，我们显著降低了 rAMR 和 rSPMR 联合 （22.2% vs 32.2%，P < 0.001） 和单独 rSPMR （22.5% vs 37.1%，P = 0.002），但没有降低 rAMR （21.8% vs 29.8%，P = 0.079）。此外，WE 显着增加了右侧结肠每次结肠镜检查 SP （SPPC） 的检出率 （0.95 ± 1.56 vs 0.50 ± 0.79，P < 0.001）。多因素 logistic 回归分析显示，右侧结肠 ≥2 个 SP 是 rSPMR 的独立预测因子 （比值比 [OR]，3.47;95% 置信区间 [CI]，1.89─6.38），以及较高的右侧结肠波士顿肠道准备量表评分 （OR，0.55;95% CI，0.32─0.94）。结论 rSPMR 的显着降低和右侧结肠 SPPC 的增加表明，使用 WE 进行结肠镜插入是 CO2 吹入的有效替代方案 （临床试验注册号：NCT04124393）。