Colonoscopy continues to be the primary means of investigating lower gastrointestinal symptoms. Colonoscopy has been shown to reduce the risk of subsequent colorectal cancer (CRC) both in screening and in the symptomatic population. However, despite its popularity, colonoscopy is not perfect, and post colonoscopy cancer is a recognized feature. Colonoscopy is the most commonly performed endoscopic procedure in the United States and is the preferred method to screening for CRC. The term “water-assisted colonoscopy” or “water-aided colonoscopy” (WAC) encompasses different techniques that entail infusion of water as an adjunct to or in inplace of gas insufflation to allow insertion of the colonoscope to the cecum. Withdrawal is done with gas insufflation to distend the lumen for exploration, as usual in AI or CO2 insufflation colonoscopy. Initially, different labels were used to identify the techniques, namely water infusion or water immersion grouped as WI. Although evidence was not adequate to prove that WE method was better for increasing cecal intubation rate, the use of WE seemed to have a higher ADR/PDR and patients’ acceptance of colonoscopy. Moreover, pooled data showed that WE relieved patients’ pain and minimized the need for on‑demand sedation and adjunct maneuvers. However, WE was demonstrated to be more time‑consuming during the insertion phase. ADR was considered to be the leading parameter of our study as the quality of endoscopist’s performance of colonoscopy is mainly defined by the capacity of detecting precancerous lesions.