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However, prolonged cecal insertion time is a drawback. This study aims to investigate the factors affecting cecal insertion during water exchange colonoscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We pooled data from five randomized clinical trials that included patients undergoing water exchange colonoscopy. Logistic analysis was performed to determine the independent factors associated with prolonged cecal insertion time (&gt;\u00a015\u00a0min).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort included 912 patients (493 men and 419 women) with a median age of 57\u00a0years (interquartile range, 49\u201364\u00a0years). The median cecal insertion time was 13.5\u00a0min (interquartile range, 10.9\u201317.0\u00a0min). Multivariate logistic regression analysis indicated that female sex, body mass index\u00a0&lt;\u00a025\u00a0kg\/m<jats:sup>2<\/jats:sup>, a history of constipation, no sedation, less experienced endoscopist, Boston Bowel Preparation Scale score\u00a0\u2264\u00a06, infused water volume during insertion\u00a0\u2265\u00a01000\u00a0mL, and scope length at the cecum\u00a0\u2265\u00a085\u00a0cm were associated with prolonged cecal insertion time. With increasing volume of infused water (1000\u20132000\u00a0mL), the median cecal insertion time increased gradually from 11.4 to 23.0\u00a0min (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current study identified independent factors associated with prolonged cecal insertion time during water exchange colonoscopy. Several factors are modifiable to achieve a shorter insertion time, including better bowel preparation, the use of sedation, more experienced endoscopist, infusing less water during insertion, and maintaining a shorter scope length.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.15869","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T05:06:17Z","timestamp":1650603977000},"page":"1326-1332","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Factors associated with prolonged cecal insertion time in patients undergoing water exchange colonoscopy"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4196-8678","authenticated-orcid":false,"given":"Yu\u2010Hsi","family":"Hsieh","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation  Chiayi Taiwan"},{"name":"School of Medicine Tzu Chi University  Hualien City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9242-9167","authenticated-orcid":false,"given":"Malcolm","family":"Koo","sequence":"additional","affiliation":[{"name":"Graduate Institution of Long\u2010term Care Tzu Chi University of Science and Technology  Hualien Taiwan"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6951-4646","authenticated-orcid":false,"given":"Chih\u2010Wei","family":"Tseng","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation  Chiayi Taiwan"},{"name":"School of Medicine Tzu Chi University  Hualien City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.02.068"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.01.014"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1309086"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.09.011"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13465"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1067\/mge.2001.118950"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2018.07.020"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.08.021"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000024907"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-018-3014-x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2020.10.011"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2006.04818.x"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.12.005"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.14839"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000000954"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15043"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2008.05.057"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(04)02461-7"},{"key":"e_1_2_6_21_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.4103\/sjg.SJG_9_19","article-title":"Factors for cecal intubation time during colonoscopy in women: impact of surgical history","volume":"25","author":"Nam JH","year":"2019","journal-title":"Saudi J. 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