Water infusion without near-complete removal during insertion by any other name is still water immersion

A network meta-analysis of randomized controlled trials (RCTs) showed that water exchange (WE) was superior to water immersion (WI) and gas (air or CO2) insufflation (air insufflation) in increasing adenoma detection rate (ADR).1 The published features of WE included water infusion to facilitate cecal intubation, gas exclusion to avoid colon elongation, and predominant (near-complete) insertion removal of water and debris to minimize distension and maximize salvage cleaning.2 For convenience (learning curve deemed unnecessary) and efficiency (less time consuming), WI did not mandate these maneuvers.

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