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Right Colon Adenoma Detectation RateNCT07456007

Right Colon Adenoma Detection Rate Using Water Exchange Versus Air Insufflation in Colonoscopy.

A study testing Right colon water exchange and Air nsufflation in people with Right Colon Adenoma Detectation Rate and Water Exchange Colonoscopy, run by Dalin Tzu Chi General Hospital at 1 site in Taiwan.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Although colonoscopy is currently regarded as the gold standard to detect and prevent colorectal cancer (CRC) but post-colonoscopy CRCs (interval cancer, IC) still occur. Recent studies demonstrated that protection by colonoscopy against right-sided colon cancer was lower than that attained in the left colon. Read more about this study

Who is it for?
Ages 40 to 80 years
What is being tested?
Right colon water exchange and Air nsufflation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
414 participants
Where
1 siteTaiwan
Study dates
9 Jun 2020to 30 Jan 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults aged 40 to 80 years.
  • Patients undergoing screening, surveillance, or diagnostic colonoscopy.
  • Colonoscopy performed by participating endoscopists.
  • Ability to provide written informed consent.

Who cannot join

  • Inability or unwillingness to provide informed consent.
  • Age < 40 years or > 80 years.
  • History of colorectal surgery (e.g., partial colectomy).
  • Known or suspected colorectal cancer.
  • Known inflammatory bowel disease (e.g., ulcerative colitis or Crohn's disease).
  • Planned therapeutic colonoscopy (e.g., polypectomy).
Show all 11Show fewer
  • Inadequate bowel preparation.
  • Known or suspected colonic obstruction or severe stricture.
  • Massive ascites.
  • Severe comorbid conditions (e.g., renal failure).
  • Emergency colonoscopy.

Trial locations and contacts

1 site in 1 country.

Taiwan1 site
  • Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation

    Chiayi City, Chiayi, 62247

Other trials in Taiwan

About this study

Official title: A Patient Blinded, Randomized, Controlled Trial Comparing Right Colon Adenoma Detection Rate in Colonoscopy Using Right Colon Water Exchange and Traditional Air Insufflation

Although colonoscopy is currently regarded as the gold standard to detect and prevent colorectal cancer (CRC) but post-colonoscopy CRCs (interval cancer, IC) still occur. Recent studies demonstrated that protection by colonoscopy against right-sided colon cancer was lower than that attained in the left colon. Adenoma detection rate (ADR) has been correlated with IC - each 1 % increase in ADR is associated with 3% decrease in the risk of ICs. Hopefully, innovations that improve right colon ADR would reduce the right colon IC. Insertion water exchange (WE), characterized by infusing water to guide the advance of the colonoscope in an airless lumen with its removal mainly during insertion. WE has been shown to improve the overall and right colon ADR compared to traditional air insufflation (Air). Several plausible causes have been proposed to explain the enhanced ADR by WE, including decreased multitasking related distraction, improved bowel cleanness, and flat polyps appearing less flatten and floating up in water Therefore, the adoption of WE in the right colon might be especially beneficial. In addition, WE has been criticized for prolonged insertion time, about 3-5 minutes longer than Air to reach the cecum and required a learning curve of about 50 to 100 cases.In this study, we devise a right colon WE method (RCWE), in which Air will be used to intubate to the hepatic flexure, followed by WE in the right colon. We test the hypothesis that RCWE would increase the right colon ADR without prolonging the insertion time. Consecutive patients undergoing screening, surveillance, or diagnostic examinations performed by participating endoscopists will be stratified for enrollment. Patients will be randomized in a 1:1 ratio (n=207 per group) to either the AI or RCWE group. Demographic data (age, gender, height, and weight), indications for colonoscopy, history of abdominal or pelvic surgery, constipation and chronic use of laxatives will be ascertained before colonoscopy. Quality of bowel preparation, cecal intubation time, withdrawal time, total procedure time, use of abdominal compression, need for change of position, presence and location of polyps and reasons for incomplete colonoscopy will be recorded. In addition, the right colon (from the hepatic flexure to cecum) insertion time and withdrawal time and infused and suction water amount will be recorded separately.

Being tested
Right colon water exchange, Air nsufflation
Keywords
water exchange colonoscopy, Right colon adenoma detection rate, colonoscopy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Right colon water exchangeBehavioural

    Air insufflation was used to advance the colonoscope to the hepatic flexure, where the insertion method was switched to water exchange (WE) to reach the cecum. This predefined transition was designed to specifically evaluate the effect of WE on right-sided colon adenoma detection.Air insufflation was applied during withdrawal in both groups.

  • Air nsufflationBehavioural

    Behavioral: Air nsufflationAir was used to minimally distend the lumen during insertion. Water (30-50 mL aliquots) was delivered via syringe as needed to clear residual stool. Carbon dioxide was not used, as it is not standard practice for colonoscopy in Taiwan. Air insufflation was applied during withdrawal in both groups.

Study groups in NCT07456007
Study groupRoleWhat they receive
Right colon water exchange groupExperimentalAir insufflation was used to advance the colonoscope to the hepatic flexure, where the insertion method was switched to water exchange (WE) to reach the cecum. This predefined transition was designed to specifically evaluate the effect of WE on right-sided colon adenoma detection.
Receives: Behavioral: Right colon water exchange
Air insufflation groupActive comparatorCecal intubation was achieved using conventional air insufflation.
Receives: Behavioral: Air nsufflation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. adenoma detection rate in proximal colon

    The proportion of patients with the presence of adenoma in the proximal colon.

    Measured: one week

Secondary outcomes (1)
  1. adenoma detection rate

    Measured: one week

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Mar 2026
  2. Study start9 Jun 2020
  3. Primary completion31 Dec 2025
  4. Study completion30 Jan 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
414 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07456007
Sponsor's protocol ID
A10802001-2
Status last verified
Mar 2026
First submitted
3 Mar 2026
Last updated
22 Jun 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Lai EJ, Calderwood AH, Doros G, Fix OK, Jacobson BC. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc. 2009 Mar;69(3 Pt 2):620-5. doi: 10.1016/j.gie.2008.05.057. Epub 2009 Jan 10.

    PubMed 19136102
  • Kudo Se, Lambert R, Allen JI, Fujii H, Fujii T, Kashida H, Matsuda T, Mori M, Saito H, Shimoda T, Tanaka S, Watanabe H, Sung JJ, Feld AD, Inadomi JM, O'Brien MJ, Lieberman DA, Ransohoff DF, Soetikno RM, Triadafilopoulos G, Zauber A, Teixeira CR, Rey JF, Jaramillo E, Rubio CA, Van Gossum A, Jung M, Vieth M, Jass JR, Hurlstone PD. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008 Oct;68(4 Suppl):S3-47. doi: 10.1016/j.gie.2008.07.052. No abstract available.

    PubMed 18805238
  • The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003 Dec;58(6 Suppl):S3-43. doi: 10.1016/s0016-5107(03)02159-x. No abstract available.

    PubMed 14652541
  • Ramirez FC, Leung FW. The water method for aiding colonoscope insertion: the learning curve of an experienced colonoscopist. J Interv Gastroenterol. 2011 Jul;1(3):97-101. doi: 10.4161/jig.1.3.18507. Epub 2011 Jul 1.

    PubMed 22163078
  • Fischer LS, Lumsden A, Leung FW. Water exchange method for colonoscopy: learning curve of an experienced colonoscopist in a U.S. community practice setting. J Interv Gastroenterol. 2012 Jul;2(3):128-132. doi: 10.4161/jig.23734. Epub 2012 Jul 1.

    PubMed 23805393
  • Hsieh YH, Koo M, Tseng CW, Yang HW, Leung FW. Reduction of multitasking distractions underlies the higher adenoma detection rate of water exchange compared to air insufflation - blinded analysis of withdrawal phase videos. United European Gastroenterol J. 2019 Mar;7(2):230-238. doi: 10.1177/2050640618817105. Epub 2018 Dec 5.

    PubMed 31080608
  • Fuccio L, Frazzoni L, Hassan C, La Marca M, Paci V, Smania V, De Bortoli N, Bazzoli F, Repici A, Rex D, Cadoni S. Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies. Gastrointest Endosc. 2018 Oct;88(4):589-597.e11. doi: 10.1016/j.gie.2018.06.028. Epub 2018 Jul 5.

    PubMed 29981753
  • Hsieh YH, Koo M, Leung FW. A patient-blinded randomized, controlled trial comparing air insufflation, water immersion, and water exchange during minimally sedated colonoscopy. Am J Gastroenterol. 2014 Sep;109(9):1390-400. doi: 10.1038/ajg.2014.126. Epub 2014 Jun 3.

    PubMed 24890443
  • Jia H, Pan Y, Guo X, Zhao L, Wang X, Zhang L, Dong T, Luo H, Ge Z, Liu J, Hao J, Yao P, Zhang Y, Ren H, Zhou W, Guo Y, Zhang W, Chen X, Sun D, Yang X, Kang X, Liu N, Liu Z, Leung F, Wu K, Fan D. Water Exchange Method Significantly Improves Adenoma Detection Rate: A Multicenter, Randomized Controlled Trial. Am J Gastroenterol. 2017 Apr;112(4):568-576. doi: 10.1038/ajg.2016.501. Epub 2016 Dec 6.

    PubMed 27922025
  • Hsieh YH, Tseng CW, Hu CT, Koo M, Leung FW. Prospective multicenter randomized controlled trial comparing adenoma detection rate in colonoscopy using water exchange, water immersion, and air insufflation. Gastrointest Endosc. 2017 Jul;86(1):192-201. doi: 10.1016/j.gie.2016.12.005. Epub 2016 Dec 15.

    PubMed 27988288
  • Cadoni S, Falt P, Rondonotti E, Radaelli F, Fojtik P, Gallittu P, Liggi M, Amato A, Paggi S, Smajstrla V, Urban O, Erriu M, Koo M, Leung FW. Water exchange for screening colonoscopy increases adenoma detection rate: a multicenter, double-blinded, randomized controlled trial. Endoscopy. 2017 May;49(5):456-467. doi: 10.1055/s-0043-101229. Epub 2017 Mar 10.

    PubMed 28282689
  • Corley DA, Jensen CD, Marks AR, Zhao WK, Lee JK, Doubeni CA, Zauber AG, de Boer J, Fireman BH, Schottinger JE, Quinn VP, Ghai NR, Levin TR, Quesenberry CP. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014 Apr 3;370(14):1298-306. doi: 10.1056/NEJMoa1309086.

    PubMed 24693890
  • Rondagh EJ, Bouwens MW, Riedl RG, Winkens B, de Ridder R, Kaltenbach T, Soetikno RM, Masclee AA, Sanduleanu S. Endoscopic appearance of proximal colorectal neoplasms and potential implications for colonoscopy in cancer prevention. Gastrointest Endosc. 2012 Jun;75(6):1218-25. doi: 10.1016/j.gie.2012.02.010. Epub 2012 Apr 5.

    PubMed 22482917
  • Gupta S, Balasubramanian BA, Fu T, Genta RM, Rockey DC, Lash R. Polyps with advanced neoplasia are smaller in the right than in the left colon: implications for colorectal cancer screening. Clin Gastroenterol Hepatol. 2012 Dec;10(12):1395-1401.e2. doi: 10.1016/j.cgh.2012.07.004. Epub 2012 Jul 24.

    PubMed 22835574
  • Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013 Sep 19;369(12):1095-105. doi: 10.1056/NEJMoa1301969.

    PubMed 24047059

Questions about this trial

What is this clinical trial studying?

A study testing Right colon water exchange and Air nsufflation in people with Right Colon Adenoma Detectation Rate and Water Exchange Colonoscopy, run by Dalin Tzu Chi General Hospital at 1 site in Taiwan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Taiwan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

adenoma detection rate in proximal colon (time frame: one week). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07456007, which also lists 19 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jun 2026.

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