A Bayesian Network Meta-Analysis: Efficacy of Air Insufflation, CO2 Insufflation, Water Exchange, and Water Immersion in Colonoscopy

Summary

Background

Colonoscopy is one of the excellent tools for screening colorectal cancer. There were four colonoscopy techniques containing air insufflation, CO₂ insufflation, water exchange, and water immersion. Some studies reported that these methods are better than the criterion standard (air insufflation), while some studies showed not. In order to evaluate the efficacy of four colonoscopy techniques, a network meta-analysis was performed in present study.

Methods

We searched randomized controlled trials (RCTs) published up to September 2017 from PubMed, Embase, Cochrane library, and Web of Science. Studies referencing the comparison between at least two of air insufflation, CO₂ insufflation, water exchange, and water immersion were selected. The primary outcomes included pain score during insertion, polyp detection rate, and adenoma detection rate, and the secondary outcomes included cecal intubation time and cecal intubation rate. MDs or ORs and their 95% CrI were pooled with Bayesian modeling.

Results

Forty RCTs with 13,734 patients were included in this network meta-analysis. Our analysis showed that air insufflation had the highest pain score (SUCRA: 98.8%) and the lowest detection rate of adenoma (SUCRA: 21.3%) and polyp (SUCRA: 16.8%). Nevertheless, water exchange had the lowest pain score (SUCRA: 1.1%) and highest detection rate of adenoma (SUCRA: 96.0%) and polyp (SUCRA: 98.9%), though it led to the longest cecal intubation time (SUCRA: 86.9%).

Conclusions

Air insufflation might be the most unsatisfying colonoscopy. Meanwhile, water exchange might be the most efficient colonoscopy.

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