Reducing Patient Discomfort through Water Exchange Esophagogastroduodenoscopy: A Single-Blind Randomized Controlled Trial

Background: The water exchange insertion technique reduces patient discomfort and improves the adenoma detection rate compared with conventional air insufflation during colonoscopy. This study investigated the efficacy of water exchange during esophagogastroduodenoscopy. Methods: A total of 250 patients undergoing unsedated esophagogastroduodenoscopy were randomly assigned to either the water exchange group (n = 130) or the air group (n = 120). In the water exchange group, water was infused using a 50 mL syringe to guide scope advancement in the stomach. The infused water was aspirated immediately to maintain a collapsed gastric lumen. The primary outcome was patient-reported discomfort during esophagogastroduodenoscopy (0 = none, 10 = worst). Secondary outcomes included patient satisfaction (0 = not satisfied, 10 = most satisfied), willingness to repeat the same method, and the number of belching episodes. Results: The discomfort score during esophagogastroduodenoscopy was significantly lower in the water exchange group than in the air group (median [interquartile range], 2 [0–4] vs. 2.5 [1–5], p = 0.026). The number of belching episodes was significantly lower in the water exchange group (1 [0–2] vs. 2 [0–5], p = 0.020). A greater proportion of patients in the water exchange group were willing to undergo esophagogastroduodenoscopy again if needed (95.4% vs. 85.8%, p = 0.014), and they reported significantly higher satisfaction scores (10 [9–10] vs. 9.5 [8–10], p = 0.024). Conclusion: Compared with conventional air insufflation, gastric water exchange during unsedated esophagogastroduodenoscopy significantly reduced patient discomfort and belching episodes while improving patient satisfaction.