Skip to content
DraconiticResearch
Search Sources API
203,234 studies31 sourcesUpdated 42 min ago
Peer-reviewedCC BY-NC-NDLancet regional health. Americas

Safety and sustainability of potable tap water irrigation in endoscopy in Canada: an interrupted time series study.

  • Hilalion San Ahn1,2
  • Husein Moloo1,2,3
  • Karlie Kelly4
  • Lisa Zhang1,2,3
  • Catherine Dube2,4
  • Alaa Rostom2,4
  • Jennifer Shamess5
  • Meghan Bourque6
  • Daniel I McIsaac3,7
7 affiliations
  1. 1Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
  2. 2University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada.
  3. 3Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  4. 4Department of Gastroenterology, The Ottawa Hospital, Ottawa, ON, Canada.
  5. 5Patient Advisor, Ottawa, ON, Canada.
  6. 6Department of Surgery, McMaster University, Hamilton, ON, Canada.
  7. 7Departments of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
Read full textPDFDOICite

Abstract

Background

International guidelines recommend sterile water for endoscopic irrigation despite limited evidence. Single-use plastic sterile water bottles generate substantial costs, greenhouse gas emissions, and microplastics. We sought to estimate whether replacing sterile water with potable tap water for endoscopic irrigation affected clinical outcomes.Methods

This quasi-experimental study involved an interrupted time series design at a multi-campus tertiary care academic health system (The Ottawa Hospital, Canada). All adults undergoing esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, enteroscopy, ileoscopy, or pouchoscopy between February 2024 and August 2025 were included. A system-wide switch to tap water took place on February 10, 2025. The primary outcome was a composite of emergency department visits, unplanned admissions, or deaths within 7 days post-procedure. Infectious complications within 30 days constituted secondary endpoints. Data were obtained from validated institutional databases. Segmented regression modeled the weekly outcome proportion to estimate the step change post-implementation, with a non-inferiority margin of <0.5% absolute risk increase.Findings

A total of 29,522 procedures were performed on 29,423 patients (18,863 pre-implementation; 10,560 post-implementation). Patient and procedural characteristics were comparable. The weekly proportion experiencing the primary outcome was 1.6% in both phases. The post-implementation step change was -0.40% (95% confidence interval [CI] -1.16 to 0.35), with the upper boundary of the 95% CI below the pre-specified non-inferiority margin of 0.5%. Results were similar for infectious complications (step change -0.23%, 95% CI -0.75 to 0.29).Interpretation

Potable tap water was non-inferior to sterile water for endoscopic irrigation with respect to clinical outcomes. These findings provide an evidence base for revising current guideline recommendations that mandate sterile water for endoscopic irrigation.Funding

This project was supported by the 2024 Canadian Society of Colorectal Surgeons Research Operating Grant.

Related

  1. Progress in flame-retardant solid-state electrolytes for battery safety and sustainability
    Chijie Ding, Weidu Li, Jiayao Zhou +4
    Cell Reports SustainabilityPeer-reviewedCC BYFull textEcologyEnvironmental science & pollutionDOAJ
  2. Artificial Intelligence in the Food Industry: Transforming Safety, Efficiency, and Sustainability From Farm to Fork
    Muhammad Waqar, Mariyam Shahid, Manat Chaijan +7
    eFoodPeer-reviewedCC BY5 citedPlant biologyOpenAlex
  3. Opisthorchis viverrini Control and Cholangiocarcinoma Incidence in Thailand: A Systematic Narrative Review and Proposed Interrupted Time Series Design
    Marcus Webb
    Zenodo (CERN European Organization for Nuclear Research)PreprintPublic domain8 citedMicrobiologyOpenAlex
  4. Egyptian Bladder Cancer: Interrupted Time Series Analysis of Schistosoma haematobium Control and Cancer Incidence, 1960-2020
    Marcus Webb
    Zenodo (CERN European Organization for Nuclear Research)PreprintPublic domain9 citedMicrobiologyOpenAlex
  5. An embedded deep learning–fuzzy logic framework for intelligent and automated irrigation in smart farming
    Ze Luo, Zhuo Yang, Yi Hu +1
    Scientific ReportsPeer-reviewedCC BY-NC-ND 4.0Full textPlant biologyCrossref

Cite

BibTeXRIS
BibTeX
@article{ahn2026safety,
  title = {{Safety and sustainability of potable tap water irrigation in endoscopy in Canada: an interrupted time series study.}},
  author = {Hilalion San Ahn and Husein Moloo and Karlie Kelly and Lisa Zhang and Catherine Dube and Alaa Rostom and Jennifer Shamess and Meghan Bourque and Daniel I McIsaac},
  journal = {Lancet regional health. Americas},
  year = {2026},
  month = oct,
  doi = {10.1016/j.lana.2026.101669},
  url = {https://europepmc.org/article/MED/42921361},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Safety and sustainability of potable tap water irrigation in endoscopy in Canada: an interrupted time series study.
AU  - Hilalion San Ahn
AU  - Husein Moloo
AU  - Karlie Kelly
AU  - Lisa Zhang
AU  - Catherine Dube
AU  - Alaa Rostom
AU  - Jennifer Shamess
AU  - Meghan Bourque
AU  - Daniel I McIsaac
PY  - 2026
DA  - 2026/10/14
JO  - Lancet regional health. Americas
DO  - 10.1016/j.lana.2026.101669
UR  - https://europepmc.org/article/MED/42921361
AB  - Background  International guidelines recommend sterile water for endoscopic irrigation despite limited evidence. Single-use plastic sterile water bottles generate substantial costs, greenhouse gas emissions, and microplastics. We sought to estimate whether replacing sterile water with potable tap water for endoscopic irrigation affected clinical outcomes.Methods  This quasi-experimental study involved an interrupted time series design at a multi-campus tertiary care academic health system (The Ottawa Hospital, Canada). All adults undergoing esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, enteroscopy, ileoscopy, or pouchoscopy between February 2024 and August 2025 were included. A system-wide switch to tap water took place on February 10, 2025. The primary outcome was a composite of emergency department visits, unplanned admissions, or deaths within 7 days post-procedure. Infectious complications within 30 days constituted secondary endpoints. Data were obtained from validated institutional databases. Segmented regression modeled the weekly outcome proportion to estimate the step change post-implementation, with a non-inferiority margin of <0.5% absolute risk increase.Findings  A total of 29,522 procedures were performed on 29,423 patients (18,863 pre-implementation; 10,560 post-implementation). Patient and procedural characteristics were comparable. The weekly proportion experiencing the primary outcome was 1.6% in both phases. The post-implementation step change was -0.40% (95% confidence interval [CI] -1.16 to 0.35), with the upper boundary of the 95% CI below the pre-specified non-inferiority margin of 0.5%. Results were similar for infectious complications (step change -0.23%, 95% CI -0.75 to 0.29).Interpretation  Potable tap water was non-inferior to sterile water for endoscopic irrigation with respect to clinical outcomes. These findings provide an evidence base for revising current guideline recommendations that mandate sterile water for endoscopic irrigation.Funding  This project was supported by the 2024 Canadian Society of Colorectal Surgeons Research Operating Grant.
SN  - 2667-193X
ER  -