Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Comparison of on Demand Sedation With Study Method Versus on Demand Sedation With Conventional Method for Performing Colonoscopy for Colorectal Cancer Screening and Surveillance
Brief Summary: Hypothesis

1. Study method achieves lower requirement for medications
2. Study method increases overall cecal intubation with comparable assessment of current experience and patient willingness to repeat future colonoscopy compared with conventional colonoscopy
3. Study method results in reduction in medication-related (cardiorespiratory) complications, faster turn around of patients, compared with conventional colonoscopy
4. Study method improves bowel preparation and increases polyp pickup rate

Colorectal cancer (CRC) screening for the high and the low risk healthy asymptomatic VA patients is being promoted (VHA directive). Compliance with this Directive will result in an increased number of VA patients undergoing colonoscopy. The demand for colonoscopy far exceeds the capacity available to perform the procedure in the VA system. The conventional practice for colonoscopy at VA facilities across the country is to perform colonoscopy under conscious sedation with air insufflation. Efficiency is governed by the fact that sedated patients require time and space for recovery and these are major limiting factors in the current setting for the use of colonoscopy for CRC screening.

Methods that maintain a high success rate and good patient assessment improve overall compliance for surveillance colonoscopy. Our preliminary experience showed that patients are able to complete successful colonoscopy without sedation in 52% of cases when colonoscopy was aided by a water infusion in lieu of air insufflation method. In this group of patients, the shortened recovery time means a quick turn around of patient and a more efficient endoscopy service. Patients are able to communicate better with the staff and physician regarding their problem and discharge instructions, and not subjected to the amnesic effect of sedation. Next day follow-up of patient by telephone contact which requires commitment of staff time can be obviated.

If this randomized study confirms the success of our preliminary findings and this technique is adopted by more endoscopists, a larger number of VA patients may benefit from less sedation complications and at the same time allow for more efficient colonoscopy screening services.


Options:
A: Arm Label: air insufflation; Type: PLACEBO_COMPARATOR; Interventions: Procedure: air insufflation | Arm Label: water immersion; Type: ACTIVE_COMPARATOR; Interventions: Procedure: water immersion | Arm Label: water exchange; Type: ACTIVE_COMPARATOR; Interventions: Procedure: water exchange | Intervention Type: PROCEDURE; Name: air insufflation; Assigned to Arm(s): air insufflation | Intervention Type: PROCEDURE; Name: water immersion; Assigned to Arm(s): water immersion | Intervention Type: PROCEDURE; Name: water exchange; Assigned to Arm(s): water exchange
B: Arm Label: Water Immersion Colonoscopy; Type: EXPERIMENTAL; Interventions: Procedure: water immersion colonoscopy | Arm Label: Standard Air Colonoscopy; Type: ACTIVE_COMPARATOR; Interventions: Procedure: standard air colonoscopy | Intervention Type: PROCEDURE; Name: water immersion colonoscopy; Assigned to Arm(s): Water Immersion Colonoscopy | Intervention Type: PROCEDURE; Name: standard air colonoscopy; Assigned to Arm(s): Standard Air Colonoscopy
C: Arm Label: Water infusion; Type: EXPERIMENTAL; Interventions: Procedure: Water infusion | Arm Label: Air insufflation; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Air insufflation | Intervention Type: PROCEDURE; Name: Water infusion; Assigned to Arm(s): Water infusion | Intervention Type: PROCEDURE; Name: Air insufflation; Assigned to Arm(s): Air insufflation
D: Intervention Type: PROCEDURE; Name: water infusion colonoscopy; Assigned to Arm(s): N/A

Answer: C