Hydrocolonoscopy – Key Concepts

Hydrocolonoscopy: A Five-Minute Introduction

When you start a colonoscopy, you have two choices: insufflate with air or CO2, or fill the lumen with water. Most endoscopists use insufflation by habit. Klaus Monkemüller uses water first on every case without contraindications. This Quick Tip shows why.

Why Water Works

Water removes stool and debris from the mucosal surface in real time. It clears the view without switching tools or pausing the procedure. It also improves patient tolerance by avoiding the distension that air causes. In areas with natural kinks or mild stenosis, water provides gentler navigation. It conforms to the lumen rather than forcing it open with pressure.

There is a downstream benefit as well. Water used during insertion loosens debris and stool from the mucosa. By the time you begin withdrawal and start suctioning, the field is already cleaner. Polyp detection and surface characterization on the way out both improve as a result.