{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T02:27:06Z","timestamp":1788834426107,"version":"build-2803163510"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":38,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"DOI":"10.1186\/s12876-025-04557-9","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:17:10Z","timestamp":1765606630000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Combined water exchange and cap-assisted colonoscopy reduces cecal intubation time and patient discomfort in patients with unsedated colonoscopy: a randomized controlled trial"],"prefix":"10.1186","volume":"26","author":[{"given":"Dongchu","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aixiang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangwu","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"issue":"1","key":"4557_CR1","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1186\/s12876-025-03707-3","volume":"25","author":"J Shan","year":"2025","unstructured":"Shan J, Su Y, Luo D, et al. Comparing the bowel cleansing efficacy between sodium picosulfate vs. 2 L polyethylene glycol electrolyte lavage solution for colonoscopy: a prospective observational study. BMC Gastroenterol. 2025;25(1):164.","journal-title":"BMC Gastroenterol"},{"key":"4557_CR2","doi-asserted-by":"publisher","first-page":"1499223","DOI":"10.3389\/fonc.2025.1499223","volume":"15","author":"M Zhu","year":"2025","unstructured":"Zhu M, Zhai Z, Wang Y, et al. Advancements in the application of artificial intelligence in the field of colorectal cancer. Front Oncol. 2025;15:1499223.","journal-title":"Front Oncol"},{"issue":"1","key":"4557_CR3","doi-asserted-by":"publisher","first-page":"13704","DOI":"10.1038\/s41598-023-40706-4","volume":"13","author":"TX Jiao","year":"2023","unstructured":"Jiao TX, Hu Y, Guo SB. Clinical value of sigmoid colon water exchange colonoscopy: a prospective randomized clinical trial. Sci Rep. 2023;13(1):13704.","journal-title":"Sci Rep"},{"issue":"2","key":"4557_CR4","doi-asserted-by":"publisher","first-page":"3577","DOI":"10.1109\/LRA.2021.3060391","volume":"6","author":"H Kim","year":"2021","unstructured":"Kim H, Kim J, You JM, et al. A Sigmoid-Colon-Straightening soft actuator with peristaltic motion for colonoscopy insertion assistance: easycolon. Ieee Rob Autom Lett. 2021;6(2):3577\u201384.","journal-title":"Ieee Rob Autom Lett"},{"issue":"2","key":"4557_CR5","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1007\/s00464-024-11442-1","volume":"39","author":"A Vajpeyi","year":"2025","unstructured":"Vajpeyi A, Naidu AS, Hawel JD, Schlachta CM, Patel RV. A multimodal training environment for colonoscopy with pressure feedback. Surg Endosc. 2025;39(2):960\u20139.","journal-title":"Surg Endosc"},{"key":"4557_CR6","unstructured":"Harkins JM, Sajjad H, Anatomy. Abdomen and Pelvis, sigmoid Colon. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023."},{"issue":"3","key":"4557_CR7","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/j.gie.2021.11.026","volume":"95","author":"DK Rex","year":"2022","unstructured":"Rex DK. Achieving cecal intubation in the difficult colon (with videos). Gastrointest Endosc. 2022;95(3):568\u201372.","journal-title":"Gastrointest Endosc"},{"issue":"6","key":"4557_CR8","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1080\/00365521.2024.2316766","volume":"59","author":"A Kim","year":"2024","unstructured":"Kim A, Kim H, Kim ER, et al. Risk factors and management of iatrogenic colorectal perforation in diagnostic colonoscopy: a single-center cohort study. Scand J Gastroenterol. 2024;59(6):749\u201354.","journal-title":"Scand J Gastroenterol"},{"key":"4557_CR9","unstructured":"Leung F. Insights into Water Exchange Colonoscopy. Gastroenterology & hepatology. 2022;18(11):664\u2013666."},{"key":"4557_CR10","doi-asserted-by":"crossref","unstructured":"Chirapongsathorn S, Suzuki S, Prasanwon P et al. Comparison of colon adenoma detection rate using transparent cap-assisted and conventional colonoscopy: result from an international trial in Asia. Digestive Diseases. 2025;43(2):215-24.","DOI":"10.1159\/000543296"},{"key":"4557_CR11","doi-asserted-by":"crossref","unstructured":"Duarte-Chang C, Zuniga Cisneros J, Da Silva Rodriguez R. Conventional colonoscopy vs. cap-assisted colonoscopy: there are differences in colonoscopy performance? Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru. [; Randomized Controlled Trial; Comparative Study; English Abstract]. 2024;44(3):252\u2013258.","DOI":"10.47892\/rgp.2024.443.1674"},{"issue":"5","key":"4557_CR12","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1136\/gutjnl-2020-321918","volume":"70","author":"MD Rutter","year":"2021","unstructured":"Rutter MD, Evans R, Hoare Z, et al. WASh multicenter randomized controlled trial: water-assisted sigmoidoscopy in english NHS bowel scope screening. Gut. 2021;70(5):845\u2013.","journal-title":"Gut"},{"issue":"10","key":"4557_CR13","doi-asserted-by":"publisher","first-page":"5704","DOI":"10.1007\/s00464-024-11075-4","volume":"38","author":"B Din\u00e7er","year":"2024","unstructured":"Din\u00e7er B, \u00d6mero\u011flu S, G\u00fcven O, et al. Factors predict prolonged colonoscopy before the procedure: prospective registry study. Surg Endosc. 2024;38(10):5704\u201311.","journal-title":"Surg Endosc"},{"issue":"3 Pt 2","key":"4557_CR14","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1016\/j.gie.2008.05.057","volume":"69","author":"EJ Lai","year":"2009","unstructured":"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;69(3 Pt 2):620\u20135.","journal-title":"Gastrointest Endosc"},{"issue":"7889","key":"4557_CR15","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/S0140-6736(74)90884-8","volume":"2","author":"EC Huskisson","year":"1974","unstructured":"Huskisson EC. Measurement of pain. Lancet. 1974;2(7889):1127\u201331.","journal-title":"Lancet"},{"issue":"1","key":"4557_CR16","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/s00384-025-04858-1","volume":"40","author":"MT Issa","year":"2025","unstructured":"Issa MT, Sultana E, Hamid M, et al. DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicenter retrospective study. Int J Colorectal Dis. 2025;40(1):68.","journal-title":"Int J Colorectal Dis"},{"issue":"2","key":"4557_CR17","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1136\/gutjnl-2022-327736","volume":"72","author":"E Morgan","year":"2023","unstructured":"Morgan E, Arnold M, Gini A, et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimate from GLOBOCAN. Gut. 2023;72(2):338\u201344.","journal-title":"Gut"},{"key":"4557_CR18","first-page":"665","volume":"92","author":"S Yilmaz","year":"2021","unstructured":"Yilmaz S, Bolukbasi H, Bozkurt MA. Factors effecting cecal intubation time during colonoscopy. Ann Ital Chir. 2021;92:665\u201370.","journal-title":"Ann Ital Chir"},{"issue":"45","key":"4557_CR19","doi-asserted-by":"publisher","first-page":"e31271","DOI":"10.1097\/MD.0000000000031271","volume":"101","author":"J Ko","year":"2022","unstructured":"Ko J, Kim HW, Kang DH, et al. Efficacy of combination colonoscopy using modified cap-assisted and water-exchange colonoscopy with prone position for detection of colorectal adenomas. Med (Baltim). 2022;101(45):e31271.","journal-title":"Med (Baltim)"},{"issue":"10","key":"4557_CR20","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.14309\/ajg.0000000000002407","volume":"118","author":"JC Anderson","year":"2023","unstructured":"Anderson JC, Rex DK. Performing High-Quality, Safe, Cost-Effective, and efficient basic colonoscopy in 2023: advice from two experts. Am J Gastroenterol. 2023;118(10):1779\u201386.","journal-title":"Am J Gastroenterol"},{"issue":"3","key":"4557_CR21","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1016\/j.gie.2019.11.016","volume":"91","author":"KC Vemulapalli","year":"2020","unstructured":"Vemulapalli KC, Tippins N, Lahr RE, et al. Impact of water filling on terminal ileum intubation with a distal-tip mucosal exposure device. Gastrointest Endosc. 2020;91(3):663\u20138.","journal-title":"Gastrointest Endosc"},{"issue":"1","key":"4557_CR22","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1111\/j.1443-1661.2007.00670.x","volume":"19","author":"T Mizukami","year":"2010","unstructured":"Mizukami T, Yokoyama A, Imaeda H, Kumai K. Collapse-submergence method: simple colonoscopic technique combining water infusion with complete air removal from the rectosigmoid colon. Dig Endoscopy. 2010;19(1):43\u20138.","journal-title":"Dig Endoscopy"},{"key":"4557_CR23","doi-asserted-by":"crossref","unstructured":"Leung CW, Kaltenbach T, Soetikno R et al. Water immersion versus standard colonoscopy insertion technique: randomized trial shows promise for minimal sedation. Endoscopy. 2010;42(7):557-63.","DOI":"10.1055\/s-0029-1244231"},{"issue":"3","key":"4557_CR24","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1016\/j.gie.2014.07.029","volume":"81","author":"S Cadoni","year":"2015","unstructured":"Cadoni S, Sanna S, Gallittu P, et al. A randomized, controlled trial comparing real-time insertion pain during colonoscopy confirmed water exchange to be superior to water immersion in enhancing patient comfort. Gastrointest Endosc. 2015;81(3):557\u201366.","journal-title":"Gastrointest Endosc"},{"issue":"3","key":"4557_CR25","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1111\/den.12406","volume":"27","author":"S Asai","year":"2015","unstructured":"Asai S, Fujimoto N, Tanoue K, Akamine E, Ogawa A. Water immersion colonoscopy facilitates straight passage of the colonoscope through the sigmoid colon without loop formation: randomized controlled trial. Dig Endosc. 2015;27(3):345\u201353.","journal-title":"Dig Endosc"},{"issue":"7","key":"4557_CR26","doi-asserted-by":"publisher","first-page":"916","DOI":"10.3109\/00365521.2015.1010569","volume":"50","author":"X Wang","year":"2015","unstructured":"Wang X, Luo H, Xiang Y, et al. Left-colon water exchange preserves the benefits of whole colon water exchange at reduced cecal intubation time conferring significant advantage in diagnostic colonoscopy - a prospective, randomized controlled trial. Scand J Gastroenterol. 2015;50(7):916\u201323.","journal-title":"Scand J Gastroenterol"},{"issue":"11","key":"4557_CR27","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1097\/MEG.0000000000000954","volume":"29","author":"CW Tseng","year":"2017","unstructured":"Tseng CW, Koo M, Hsieh YH. Cecal intubation time between cap-assisted water exchange and water exchange colonoscopy: a randomized-controlled trial. Eur J Gastroenterol Hepatol. 2017;29(11):1296\u2013302.","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"9","key":"4557_CR28","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.1016\/j.cgh.2021.04.023","volume":"19","author":"E Waldmann","year":"2021","unstructured":"Waldmann E, Kammerlander AA, Gessl I, et al. Association of adenoma detection rate and adenoma characteristics with colorectal cancer mortality after screening colonoscopy. Clin Gastroenterol Hepatol. 2021;19(9):1890\u20138.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"5","key":"4557_CR29","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1136\/flgastro-2022-102371","volume":"14","author":"LJ Neilson","year":"2023","unstructured":"Neilson LJ, Dew R, Hampton JS, Sharp L, Rees CJ. Quality in colonoscopy: time to ensure National standards are implemented? Frontline Gastroenterol. 2023;14(5):392\u20138.","journal-title":"Frontline Gastroenterol"},{"issue":"8","key":"4557_CR30","doi-asserted-by":"publisher","first-page":"2229","DOI":"10.1007\/s10620-020-06049-0","volume":"65","author":"S Ng","year":"2020","unstructured":"Ng S, Sreenivasan AK, Pecoriello J, Liang PS. Polyp detection rate correlates strongly with adenoma detection rate in trainee endoscopists. Dig Dis Sci. 2020;65(8):2229\u201333.","journal-title":"Dig Dis Sci"},{"issue":"7","key":"4557_CR31","doi-asserted-by":"publisher","first-page":"1326","DOI":"10.1111\/jgh.15869","volume":"37","author":"YH Hsieh","year":"2022","unstructured":"Hsieh YH, Koo M, Tseng CW. Factors associated with prolonged cecal insertion time in patients undergoing water exchange colonoscopy. J Gastroenterol Hepatol. 2022;37(7):1326\u201332.","journal-title":"J Gastroenterol Hepatol"},{"issue":"5","key":"4557_CR32","first-page":"471","volume":"77","author":"S Oka","year":"2023","unstructured":"Oka S, Harada K, Yamamoto S, et al. Low patient weight and long intubation time are key factors for pain during colonoscopy. Acta Med Okayama. 2023;77(5):471\u20138.","journal-title":"Acta Med Okayama"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04557-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-025-04557-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04557-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T12:04:05Z","timestamp":1768910645000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12876-025-04557-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,13]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4557"],"URL":"https:\/\/doi.org\/10.1186\/s12876-025-04557-9","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,13]]},"assertion":[{"value":"29 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Ethics Committee of Wuhan Fourth Hospital (KY2024-110-01) on 28 April 2024 and This study was registered in the Chinese Clinical Trial Registry (ID: ChiCTR2500102387). The study was conducted in accordance with the Declaration of Helsinki.All participants provided prior written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"42"}}