Efficacy of cap-assisted endoscopy for the visualization of the major duodenal papilla: a systematic review and meta-analysis

Abstract

The current standard of practice is to use a duodenoscope for the evaluation of major duodenal papilla (MDP). Recently, cap-assisted endoscopy (CAE) which uses a transparent cap at the tip of a standard front-viewing endoscope emerged as an alternative. A systematic literature search was performed at several databases from inception to January 2023 to identify studies evaluating the efficacy of CAE for the evaluation of MDP. A total of nine studies including 806 patients met our inclusion criteria. The pooled rate of technical success for CAE was 93.2% [85.6%-96.9%, I2=84.6%]. A subgroup analysis comparing CAE with standard endoscope showed higher odds for the evaluation of MDP with CAE (but not a duodenoscope which was better than CAE) with OR=57.294 [17.767-184.755, I2=45.303%]. CAE offers a significant advantage with high rates of complete MDP evaluation compared to standard forward endoscopy. However, CAE is associated with lower rates of success when compared to side-viewing endoscopes.