Tu1326 Cap-Assisted Upper Endoscope Versus Cap-Assisted Colonoscope for Difficult Sigmoid Colon: a Prospective Randomized Study

Abstract

Cap-Assisted Upper Endoscope Versus Cap-Assisted Colonoscope for Difficult Sigmoid Colon: a Prospective Randomized Study Seon-Young Park*, Ho-Seok Ki, Chunghwan Jun, Chang-Hwan Park, Hyun-Soo Kim, Sung Kyu Choi, Jong-Sun Rew Chonnam National University School, Gwang-Ju, Republic of Korea Background/Aims: Studies have estimated that failure of cecal intubation occurs with conventional colonoscope around 10% of cases. Various methods have been adopted to improve cecal intubation rates, including a transparent cap and special scopes, such as variable-stiffness colonoscope, upper endoscope, pediatric endoscope and enteroscope. The objective of the study is to assess the efficacy of cap-assisted upper endoscope compared with cap-assisted colonoscope for complete examination of the colon in patients with technically difficult sigmoid colon. Methods: One hundred and thirty nine patients with technically difficult sigmoid colon were randomly assigned to receive colonoscopy with either cap-assisted upper endoscope (E-cap, n 69) or capassisted colonoscope (C-cap, n 70). The primary endpoint was cecal intubation rate. Secondary end points included cecal intubation time, self-assessed pain score and endoscopist-assessed pain score. Results: Clinical characteristics were not different between two groups. Cecal intubation rate was significantly higher in the ‘E-cap’ (65/69, 94.2%) than in the ‘C-cap’ (50/70, 71.4%, p 0.0001). No statistically significant difference was found between two groups regarding cecal intubation time and total procedure time. Self-assessed pain (moderate to severe) was more frequently reported in the ‘C-cap’ (14/70, 20.0%) than in the ‘E-cap’ (5/69, 7.2%, p 0.029). Endoscopist-assessed pain (moderate to severe) was more frequently reported in the ‘C-cap’ (13/70, 18.6%) than in the ‘E-cap’ (3/69, 7.2%, p 0.009). Cecal intubation rate was significantly higher in the ‘E-cap’ (37/38, 97.4%) than in the ‘C-cap’ (15/29, 51.7%, p 0.0001) in patients with low body mass index (BMI 22 kg/m). Conclusion: A cap-assisted upper endoscope is more tolerable and effective than a cap-assisted colonoscope for complete examination of the colon in patients with technically difficult sigmoid colon.