| Objective: The aim of this meta-analysis was to compare the water-aided colonoscopy with the traditional air insufflation colonoscopy,to confirm which is more effective than the other in many ways, such as the patients’ endurance, the success rate of intubation, the operation time, the disease detection rate, and so on,for providing the basis for improvement to the method of clinical colonoscopy. Methods: After the search strategy was established,all relevant studies that compared wate-aided method with air insufflation in colonoscopy from Medline, Embase, Pub Med, Cochrane Central Trials, CNKI and CBM were searched and checked by inclusion criteria and exclusion criteria extending up to September 2014, the references which were lated to our theme of the articles were also searched and checked. The data was extracted independently by two members of us, and the disagreements were resolved by discussions with the third party. The following items were collected from the selected literatures: first author, year of publication, country, language, publication format, the number of patients, sex and age of patients, sedation mode, pain scores during the procedure, cecal intubation rate, cecal intubation time, total procedure time, polyp detection rate, adenoma detection rate, patients’ willingness to repeat the procedure. Then, quality assessment of the selected trails was performed with the Cochrane ‘Risk of bias’ assessment toolaccording to selection bias, performance bias, detection bias, attrition bias, reporting bias and so on, the final result was made out to two graph by using the statistical software Rev Man5.0. At last, statistical analysis was executed with STATA Software, version 12.0 SE, for studies in the absence of heterogeneity, a fixed effect model was used for the meta-analysis; otherwise, a random effects model was adopted. The bias for each of the groups was assessed by using a funnel plot. Results: 10 studies involving 2312 patients were included. ①In the respect of the the operation time, the cecal intubation time(1.646; 95%CI: 1.219 to 2.073; P = 0.000) and total procedure time(2.111; 95%CI: 1.508 to 2.713; P = 0.000) is longer in water-aided colonoscopy compared to the air insufflation colonoscopy; ②the cecal intubation rate(OR: 0.868; 95%CI: 0.368 to 2.047; P = 0.747) and polyp detection rate(OR: 1.078; 95%CI: 0.856-1.357; P = 0.523) are not significant different;③in the respect of patients’ endurance, the patients who take water method have lower pain score(-1.489; 95%CI:-1.893 to-1.086; P = 0.000) and lower on-demand sedation/analgesia rate(OR: 0.421; 95%CI: 0.328 to 0.539; P = 0.000); ④the water-aided colonoscopy has higher adenoma detection rate(OR: 1.239; 95%CI: 1.034 to 1.486; P = 0.020) and higher rate of patients willing to repeat(OR: 2.298; 95%CI: 1.614 to 3.271; P = 0.000). The shape of the funnel plots do not reveal obvious asymmetry, shows that there is no obvious publication bias of these meta-analyses. Although the water-aided method takes longer time for colonoscopy, it is actually more comfortable, more acceptable and moreeffective than the traditional air insufflation method. Considered of the possible bias, heterogeneity of included RCTs and lacking of Asian data, more RCTs with large sample size, low risk of bias, especially RCTs from Asia are required in future researches. There are still some other factors, for example, the bowel preparation, the costs, the equipments needed and complications haven’t been totally clear yet, all of these above needing to be further studied. |
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