S604 The Evolving Practice of Water-Aided Colonoscopy (WAC) – An International Survey of Colonoscopists
Bibliographic record
Abstract
Introduction: A water-aided technique (water immersion, WI) as an adjunct to gas insufflation was described in 1984. Water was infused to aid insertion through colonic segments deformed by diverticulosis, and the infused water was removed during withdrawal. Water exchange (WE) was described in 2010. Water infusion without air was used to aid insertion, followed by almost simultaneous removal of the infused water to minimize distention and to provide salvage cleaning. Worldwide, >80 reports on water-aided colonoscopy (WAC) have been published by 2020, documenting a steady growth in WE usage. A modified Delphi consensus review on WAC (GIE 2021;93:1411) reported that WE produces less pain and higher adenoma detection rates (ADR) than WI; underwater resection (UWR) is feasible, and has been applied to routine and salvage polypectomy. Methods: IWATERS (International Water-Aided Technique for Endoscopy and Research Society) conducted a survey to assess the clinical practice of WAC. Factors that might affect uptake of WAC were explored: colonoscopist demographics and experience, practice settings, allocated procedure time, the learning medium, perceived ease of learning and learning preference. A survey link was e-mailed to 55 co-authors of the Delphi review and distributed to their colleagues and trainees. Results: One hundred responses were received (from 84 practicing clinicians, 16 trainees). Responses with >80% affirmative answers (Table 1a) included: use of WAC, unlearning old methods to learn WAC is easier than expected, learning WAC is easy, clinical practice is in constant flux, WAC provides gains for my practice, have time to implement WAC, promote WAC in my practice, positive outcomes WAC vs. gas (air or CO2), and no reservations using WAC. Learning WAC was predominantly through coaching by mentors or colleagues and in a lesser degree from reading, viewing videos or attending seminars. Table 1b shows that more use of WI in respondents with usual scheduled colonoscopy time ≤30 minutes (p=0.026); and more use of WE (p=0.043) in respondents with usual scheduled colonoscopy time >30 minutes Conclusion: After learning the methods from mentors or colleagues, the surveyed endoscopists implement WAC (WI or WE) in their practice for the perceived positive benefits WAC provides their patients, even at the expense of increased procedure time (10 min) for WE. Coaching appeared to be the most popular method to acquire WAC skills. Usual scheduled colonoscopy time >30 min favors the use of WE.Figure 1.: Demographics and survey responses.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".