Cap-assisted Colonoscopy Research Articles

Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials.

Background and study aims Standard colonoscopy (SC) is the preferred modality for screening for colon cancer; however, it carries a significant polyp/adenoma miss rate. Cap-assisted colonoscopy (CC) has been shown to improve polyp/adenoma detection rate, decrease cecal intubation time and increase cecal intubation rate when compared to standard colonoscopy (SC). However, data on adenoma detection rate (ADR) are conflicting. The aim of this meta-analysis was to compare the performance of CC with SC for ADR among high-quality randomized controlled trials. Patients and methods We performed an extensive literature search using MEDLINE, EMBASE, Scopus, Cochrane and Web of Science databases and abstracts published at national meetings. Only comparative studies between CC and SC were included if they reported ADR, adenoma per person (APP), cecal intubation rate, and cecal intubation time. The exclusion criterion for comparing ADR was studies with Jadad score ≤ 2. The odds ratio (OR) was calculated using Mantel-Haenszel method. I 2 test was used to measure heterogeneity among studies. Results Analysis of high-quality studies (Jadad score ≥ 3, total of 7 studies) showed that use of cap improved the ADR with the results being statistically significant (OR 1.18, 95 % CI 1.03 – 1.33) and detection of 0.16 (0.02 – 0.30) additional APP. The cecal intubation rate in the CC group was 96.3 % compared to 94.5 % with SC (total of 17 studies). Use of cap improved cecal intubation (OR 1.61, 95 % CI 1.33 – 1.95) when compared to SC ( P value < 0.001). Use of cap decreased cecal intubation time by an average of 0.88 minutes (95 % CI 0.37 – 1.39) or 53 seconds. Conclusions Meta-analysis of high-quality studies showed that CC improved the ADR compared to SC.

Cecal intubation time between cap-assisted water exchange and water exchange colonoscopy: a randomized-controlled trial.

The water exchange (WE) method can decrease the discomfort of the patients undergoing colonoscopy. It also provides salvage cleansing and improves adenoma detection, but a longer intubation time is required. Cap-assisted colonoscopy leads to a significant reduction in cecal intubation time compared with traditional colonoscopy with air insufflation. The aim of this study was to investigate whether combined cap-assisted colonoscopy and water exchange (CWE) could decrease the cecal intubation time compared with WE. A total of 120 patients undergoing fully sedated colonoscopy at a regional hospital in southern Taiwan were randomized to colonoscopy with either CWE (n=59) or WE (n=61). The primary endpoint was cecal intubation time. The mean cecal intubation time was significantly shorter in CWE (12.0 min) compared with WE (14.8 min) (P=0.004). The volume of infused water during insertion was lower in CWE (840 ml) compared with WE (1044 ml) (P=0.003). The adenoma detection rate was 50.8 and 47.5% for CWE and WE, respectively (P=0.472). The Boston Bowel Preparation Scale scores were comparable in the two groups. Results from the multiple linear regression analysis indicated that WE with a cap, a higher degree of endoscopist's experience, a higher Boston Bowel Preparation Scale score, and a lower volume of water infused during insertion, without abdominal compression, without change of position, and without chronic laxative use, were significantly associated with a shorter cecal intubation time. In comparison with WE, CWE could shorten the cecal intubation time and required lower volume of water infusion during insertion without compromising the cleansing effect of WE.

Combined Cap-Assisted Total Water With Chromoendoscopy Further Enhance Proximal Adenoma Detection (ADR) and Hyperplastic Polyp Detection: A Retrospective Analysis

Introduction: Missed lesions in proximal colon contribute to interval cancers. Water exchange (WE) combined with chromoendoscopy increased ADR (JIG2012;3:114). Cap-assisted WE further increased ADR (GIE2013;77:944). Combined use of cap-assisted total water colonoscopy, eliminating air, further increased proximal ADR in screening cases. We hypothesize that combined cap-assisted total water with chromoendoscopy on scope withdrawal can further improve proximal ADR in surveillance colonoscopy.Table: Table. Patients demographics, volume of water used, cecal intubation and bowel preparation scoreTable: Table. Adenomas and hyperplastic polyps detection in proximal colonMethods: Retrospective analysis of 3 consecutive series of patients examined with cap-assisted water exchange (CAWE), cap-assisted total water (CATW) and combined cap-assisted total water and chromoendoscopy (CATWC) (with 0.002% indigocarmine/water). CAWE was performed with air turned off and water was infused to facilitate scope insertion while dirty water was suctioned on insertion and withdrawal. Air was used on withdrawal to facilitate examination/removal of lesions. Insertion method was same as CAWE for CATW and CATWC. In CATW, plain water was used and exchanged, with air pockets suctioned to facilitate examination. In CATWC, indigocarmine solution was infused upon withdrawal from cecum and dirty water was exchanged. In both groups, no air was used for entire examination, and polypectomy was done underwater. Small (<5 mm) polyps were removed with biopsy forceps; 5-8 mm polyps, cold snare; and >8 mm polyps, hot snare. Results: 105 patients (35 per group) were included. Patients' demographics were comparable, with no difference in mean interval between index screening and surveillance colonoscopy (4; 4.12; 4.14 years respectively). Total amount of water infused and suctioned were comparable between CATW and CATWC but significantly more than CAWE, and so was the withdrawal time. The overall and proximal ADRs (< 5mm) were higher for CATWC compared with CATW and CAWE (P<0.05). The proximal hyperplastic polyp detection rate was significantly higher for CATWC when compared to CATW and CAWE (40% vs.14.3% vs.14.3% respectively, P<0.05). Conclusion: Limitations: retrospective analysis of consecutive series with small number of patients. Combined cap-assisted total water and chromoendoscopy (CATWC) further improved proximal ADR especially <5mm adenomas. It significantly increased detection of proximal hyperplastic polyps (closely related to sessile serrated polyps) (CGH2013;11:760) in surveillance colonoscopy. These intriguing preliminary data deserves to be confirmed in a prospective RCT.

The use of a transparent cap in sigmoidoscopy-A randomized controlled clinical trial on pain, time and success rate.

Trials on cap-assisted colonoscopy have shown a reduction in pain, faster intubation time and a higher success rate attributed to the use of the cap. No similar studies have been published on sigmoidoscopy even though it is a common procedure associated with significant pain. Our objective was to investigate whether the use of a transparent cap for sigmoidoscopy has an impact on pain, time or success rate. To mimic the tendencies of daily clinical practice, the trainee endoscopist performed the procedures, and no analgesics or sedatives were used. We conducted a randomized, controlled clinical trial with a parallel design consisting of two groups masked for the intervention. The primary endpoint was pain, recorded on a 100-mm visual analogue scale (VAS). Our results found cap-assisted sigmoidoscopy to be significantly more painful than non-cap-assisted sigmoidoscopy (median VAS 50 vs. 38mm; p=0.047). We found no differences on time or success rate due to the cap. Our results suggest pain management, e.g. analgesics which is not routinely used for sigmoidoscopy, when a cap is used to gain therapeutic or diagnostic advantages. ClinicalTrials.gov Identifier: NCT02243930.

Impact of cap-assisted colonoscopy on the learning curve and quality in colonoscopy: a randomized controlled trial

Colonoscopy competency assessment in trainees traditionally has been informal. Comprehensive metrics such as the Assessment of Competency in Endoscopy (ACE) tool suggest that competency thresholds are higher than assumed. Cap-assisted colonoscopy (CAC) may improve competency, but data regarding novice trainees are lacking. We compared CAC versus standard colonoscopy (SC) performed by novice trainees in a randomized controlled trial. All colonoscopies performed by 3 gastroenterology fellows without prior experience were eligible for the study. Exclusion criteria included patient age<18 or >90 years, pregnancy, prior colon resection, diverticulitis, colon obstruction, severe hematochezia, referral for EMR, or a procedure done without patient sedation. Patients were randomized to either CAC or SC in a 1:1 fashion. The primary outcome was the independent cecal intubation rate (ICIR). Secondary outcomes were cecal intubation time, polyp detection rate, polyp miss rate, adenoma detection rate, ACE tool scores, and cumulative summation learning curves. A total of 203 colonoscopies were analyzed, 101 in CAC and 102 in SC. CAC resulted in a significantly higher cecal intubation rate, at 79.2% in CAC compared with 66.7% in SC (P= .04). Overall cecal intubation time was significantly shorter at 13.7 minutes for CAC versus 16.5 minutes for SC (P=.02). Cecal intubation time in the case of successful independent fellow intubation was not significantly different between CAC and SC (11.6 minutes vs 12.7 minutes; P= .29). Overall ACE tool motor and cognitive scores were higher with CAC. Learning curves for ICIR approached the competency threshold earlier with cap use but reached competency for only 1 fellow. The polyp detection rate, polyp miss rate, and adenoma detection rate were not significantly different between groups. CAC resulted in significant improvement in ICIR, overall ACE tool scores, and trend toward competency on learning curves when compared with SC in colonoscopy trainees without prior colonoscopy experience. (Clinical trial registration number: NCT02472730.).

Cap-Assisted Colonoscopy Improves Right Colon Adenoma Detection

Previous meta-analyses show that cap-assisted colonoscopy improves detection of small adenomas. Cap-assisted refers to placement of a short cap or hood

Polyp missing rate and its associated risk factors of referring hospitals for endoscopic resection of advanced colorectal neoplasia.

Missed polyps are frequently observed in surveillance colonoscopy or referral resection. We evaluated the polyp missing rate and its associated risk factors in patients who were referred to a tertiary hospital for endoscopic resection of advanced colorectal neoplasia.A total of 388 patients with advanced neoplasia who underwent colonoscopy in their referring hospitals and only endoscopic resection without total colonoscopy in Pusan National University Yangsan Hospital from 2009 to 2014 and who underwent surveillance colonoscopy within 6 to 12 months were retrospectively analyzed.The per-patient missing rate for polyps, adenomas, and advanced neoplasia in referring hospital were 58.2% (226 cases), 47.2% (183 cases), and 5.7% (22 cases), respectively. The advanced neoplasia in surveillance colonoscopy comprised the following: ≥1 cm lesions (11 cases, 50%), high-grade dysplasia (4 cases, 18.2%), villous adenoma (4 cases, 18.2%), and invasive cancer (3 cases, 13.6%). Risk factors for missed adenomas in multivariate analysis were ≥60 years (P = .004), male (P <.001), and no usage of the cap-assisted colonoscopy (P = .015). Missed polyps/adenomas were most frequent in the ascending colon (P <.001).The missing rate for polyps/adenomas of referring hospitals was higher than expected. Especially, patients with old age or male, or no usage of cap-assisted colonoscopy on initial colonoscopy were at increased risk of missed adenoma. Careful complete colonoscopy during referral resection or early surveillance colonoscopy is mandatory in the patients with advanced colorectal neoplasia and unknown-quality index colonoscopy.

Sa1114 The Use of Cap-Assisted Colonoscopy for Improving Endoscopy Training: A Randomized Control Trial

Sa1114 The Use of Cap-Assisted Colonoscopy for Improving Endoscopy Training: A Randomized Control Trial

Cap-Assisted Colonoscopy Increases Detection of Advanced Adenomas and Polyps

BackgroundCap-assisted colonoscopy (CAC) has been reported to increase the adenoma detection rate (ADR) in Asian population. However, CAC trials in non-Asian population have had conflicting results. Studies in North America have shown an improvement in ADRs with the use of CAC, but it mainly included white and African American patients. Given the lack of prospective studies of CAC in Hispanics, we conducted this randomized controlled trial. Materials and MethodsThis is a randomized controlled trial comparing CAC with standard colonoscopy (SC) in patients undergoing screening or surveillance colonoscopy. Our primary outcome was the ADR. Secondary outcomes were polyp detection rate, mean polyp and ADR, advanced ADR (AADR) and detection rates based on polyp morphology and location. ResultsA total of 440 patients were included in the study (88.5% Hispanic). Cecal and terminal ileum intubation rates were similar in both groups (CAC: 97% and 86% versus SC: 99% and 81%, respectively). CAC did not improve ADR in comparison with SC (0.65 versus 0.52; P = 0.079); however, CAC had a higher AADR in comparison with SC (9.9% versus 4.6%; P = 0.049). CAC detected significantly more pedunculated polyps as compared with flat and sessile polyps (P = 0.011). Complication rates were similar in the CAC and SC groups (0.9% versus 0%). ConclusionsIn a predominantly Hispanic population, no difference was seen in the mean ADR with the use of CAC. However, CAC, when compared with SC, resulted in an increased AADR and mean polyp detection rate.

Cap-assisted colonoscopy versus standard colonoscopy: is the cap beneficial? A meta-analysis of randomized controlled trials.

Background:In an effort to improve visualization during colonoscopy, a transparent plastic cap or hood may be placed on the end of the colonoscope. Cap-assisted colonoscopy (CAC) has been studied and is thought to improve polyp detection. Numerous studies have been conducted comparing pertinent clinical outcomes between CAC and standard colonoscopy (SC) with inconsistent results.Methods:Numerous databases were searched in November 2016. Only randomized controlled trials (RCTs) involving adult subjects that compared CAC to SC were included. Outcomes of total colonoscopy time, time to cecum, cecal intubation rate, terminal ileum intubation rate, polyp detection rate (PDR), and adenoma detection rate (ADR) were analyzed in terms of odds ratio (OR) or mean difference (MD) with fixed effect and random effects models.Results:Five hundred eighty-nine articles and abstracts were discovered. Of these, 23 RCTs (n=12,947) were included in the analysis. CAC showed statistically significant superiority in total colonoscopy time (MD -1.51 min; 95% confidence interval [CI] -2.67 to -0.34; P<0.01) and time to cecum (MD -0.82 min; 95%CI -1.20 to -0.44; P<0.01) compared to SC. CAC also showed better PDR (OR 1.17; 95%CI 1.06-1.29; P<0.01) but not ADR (OR 1.11; 95%CI 0.95-1.30; P=0.20). In contrast, on sensitivity analysis, ADR was better with CAC. Terminal ileum intubation and cecal intubation rates demonstrated no significant difference between the two groups (P=0.11 and P=0.73, respectively).Conclusions:The use of a transparent cap during colonoscopy improves PDR while reducing procedure times. ADR may improve in cap-assisted colonoscopy but further studies are required to confirm this.

Comparación de la prevalencia de adenomas detectados mediante colonoscopio con «CAP» accesorio (endocuff) versus colonoscopio estándar

IntroductionCAP-assisted colonoscopy (CAP) is a simple technique where use is made of plastic cylinder placed at the tip of the colonoscope. This plastic cylinder has extensions that can separate the colonic folds and enhance the field of observation, thus permitting the inspection of difficult to evaluate areas. Studies have been conducted to assess the effect of the CAP assisted colonoscopy in detecting polyps, with conflicting results. ObjectiveTo compare the number of polyps detected by CAP-assisted colonoscopy versus standard colonoscopy. Patients and MethodsA cross-sectional, comparative, randomized, experimental trial was conducted on patients that were randomised into 2 groups using a random numbers table. Group A was to standard colonoscopy, and the B group to CAP-assisted colonoscopy. ResultsA total of 147 patients were included, of which 2 were excluded because their work-up was incomplete. The remaining 145 patients, of whom 66.2% (96) were women and 33.8% (49) were men, were randomised into 2 groups. The mean age was 52.68 ±14.08 years. Group A included 72 (49.7%) patients, and Group B with 73 (50.3%) patients. There was no difference in the caecal intubation time between the 2 groups. A total of 33 (22.8%) colorectal polyps were found in 54 patients, of which 23 (31.9%) were detected with CAP and 10 (13.7%) without CAP. (P=.009). Mann-Whitney tests were also used, which showed that there was a significant difference in the number of polyps found between the CAP group and the standard colonoscopy group. ConclusionThe study demonstrated that the use of CAP is associated with improved detection of the number of polyps. The caecal intubation time is not affected by the use of CAP.

The efficacy of cap-assisted colonoscopy performed by a single endoscopist in patients after colorectal resection.

Background:The use of a transparent cap is regarded as a simple method to obtain better outcomes compared with standard colonoscopy. In this study, we investigated whether cap-assisted colonoscopy can improve the quality of procedure-related outcomes in patients with a history of colorectal resection.Methods:This study was designed as a prospective, randomized, controlled trial conducted at a single tertiary center by a single endoscopist (Kang J.). A total 183 patients after colorectal resection due to primary colorectal cancer were enrolled and 1:1 randomized to undergo either cap-assisted colonoscopy (CAP group) or standard colonoscopy (non-CAP group). The primary endpoint was the comparison of cecal intubation time between the 2 groups.Results:The mean cecal intubation time of the CAP group (n = 89) was significantly shorter than that of the non-CAP group (n = 89) (538 seconds vs 677 seconds, P = 0.024). In the CAP group, the endoscopist performed faster intubation than average more often compared with the non-CAP group (71.9% vs 57.3%). In regard to moving average curve, the CAP group showed a gentle slope during the learning period, while the non-CAP group showed a steep decrease.Conclusion:The cap-assisted colonoscopy could reduce cecal intubation time and achieve more frequent faster intubation compared with standard colonoscopy in patients after colorectal resection.

Prolonged cecal insertion time is associated with decreased adenoma detection

The adenoma detection rate (ADR) is an important colonoscopy quality parameter. A longer withdrawal time is associated with increased adenoma detection; however, the effect of cecal insertion time on adenoma detection is unclear. The aim of this study was to evaluate if cecal insertion time is associated with adenoma detection. The study included 50- to 89-year-old subjects undergoing an elective outpatient colonoscopy as part of a randomized trial on cap-assisted colonoscopy. The primary outcome was the adjusted mean number of adenomas per patient across quartiles of lengthening patient insertion times. Secondary outcomes included the mean number of advanced adenomas, ADR, and advanced ADR. Adjusted regression analysis was applied to assess for a possible trend. Among 1043 included study subjects, the median cecal insertion time was 5.3 minutes (interquartile range [IQR], 3.5-8.1) and the median withdrawal time was 8.6 minutes (IQR, 7.1-10.7). Cecal insertion time was not associated with withdrawal time (P= .950). The mean number of adenomas per patient decreased across increasing insertion time quartiles from 1.1 to .7, corresponding to a 11% decline per quartile (P= .031). Similarly, the number of advanced adenomas decreased from .15 to .06, corresponding to a 7% decline per quartile (P= .013). The observed decrease in adenoma detection was similar for proximal and distal adenomas. Endoscopists' individual insertion times were not associated with adenoma detection. A longer cecal insertion time was associated with a decreased detection of adenomas and advanced adenomas. A long insertion time may be a marker for a more difficult examination that requires a longer withdrawal time to assure adequate examination and adenoma detection. (Clinical trial registration number: NCT01935180.).

Quality of optical diagnosis of diminutive polyps and associated factors

The aim of the study was to identify endoscopist-related and procedural factors that may be associated with the quality of optical diagnosis of diminutive polyps using narrow-band imaging (NBI). All subjects who participated in a randomized trial on cap-assisted colonoscopy were eligible for the current study. Optical polyp diagnosis was an a priori outcome of the initial trial. Ten participating endoscopists used NBI to assess all of the diagnosed polyps as adenomatous or non-adenomatous in real-time and provided a degree of diagnostic certainty. The main outcome measures were quality benchmarks of optical diagnosis (negative predictive value [NPV] for diminutive rectosigmoid adenomas, agreement with pathology-based surveillance interval) and assessment of endoscopist-related and procedural factors potentially associated with the quality of optical diagnosis. A total of 1650 polyps were found in 607 patients, with 1311 polyps (79 %) being diminutive, of which 672 (53 %) were adenomatous. The NPV of optical diagnosis for rectosigmoid adenomas was 95 %. The optical diagnosis-based surveillance interval agreed with the pathology-based recommendation in 93 % of patients. Prior experience with image-enhanced endoscopy had no effect on optical diagnosis. Low and high adenoma detectors were not different in achieving the quality benchmarks. Cap-assisted colonoscopy was not associated with quality of optical diagnosis. Quality metrics of optical diagnosis remained similar during the first and second half of the study period. High quality optical diagnosis of diminutive polyps can be achieved and sustained by endoscopists previously inexperienced in this practice with minimal training. None of the examined factors appear to affect the quality of optical diagnosis; particularly, endoscopists' adenoma detection was not associated with optical diagnosis.

Tu1003 Cap-Assisted Colonoscopy (CAC) Significantly Increases the Detection of Right Sided Colonic Adenomas: A Systematic Review and Meta-Analysis

Tu1003 Cap-Assisted Colonoscopy (CAC) Significantly Increases the Detection of Right Sided Colonic Adenomas: A Systematic Review and Meta-Analysis

Tu1039 Cap-Assisted Colonoscopy Improves Cecal Intubation Rate and Time: A Systematic Review and Meta-Analysis

Tu1039 Cap-Assisted Colonoscopy Improves Cecal Intubation Rate and Time: A Systematic Review and Meta-Analysis

Mo1007 Cap-Assisted Colonoscopy Versus Standard Colonoscopy: Is the Cap Beneficial? A Meta-Analysis of Randomized Controlled Trials

Mo1007 Cap-Assisted Colonoscopy Versus Standard Colonoscopy: Is the Cap Beneficial? A Meta-Analysis of Randomized Controlled Trials

Mo1744 Impact of Cap-Assisted Colonoscopy on Adenoma Detection Rate: A Meta-Analysis of High Quality Randomized Controlled Trials

Mo1744 Impact of Cap-Assisted Colonoscopy on Adenoma Detection Rate: A Meta-Analysis of High Quality Randomized Controlled Trials

New Colonoscopy Devices to Improve Colon Neoplasm Detection

Early detection and removal of adenomatous polyps can prevent the development of colorectal cancer. However, it is fairly common-up to 20%-for polyps to be undetected in a colonoscopy due to poor visualization of the proximal aspect of colonic folds and anatomical flexures. To overcome these limitations, many new endoscopes and accessories have been developed. A wide-angle colonoscopy did not improve the detection of adenoma compared with the standard colonoscopy. An extra-wide angle and Retroview colonoscopies showed a significantly lower miss rate of polyps in the colon model. However, clinical trials are mandatory in the future. The recently introduced full spectrum endoscopy system showed a significantly higher adenoma detection rate than the standard forward-viewing colonoscopy. In accessories, The cap-assisted colonoscopy showed only a marginal or no benefit on the detection of polyps and adenomas. In contrast, a colonoscopy with Endocuff, EndoRings, and G-eye have showed significantly lower adenoma miss rates. The Third Eye, which provides additional retrograde viewing, has revealed a significant improvement in the detection of adenoma and polyp. However, the Third Eye Retroscope was limited by its deployment through the working channel of the scope. Recently, the Third Eye Panoramic cap, which was designed to overcome the limitation of the Third Eye Retroscope, was introduced. In the future, this would be needed to evaluate the effectiveness, efficiency and safety for these new colonoscopies and accessories.

Cap-assisted colonoscopy and detection of Adenomatous Polyps (CAP) study: a randomized trial.

Cap-assisted colonoscopy has improved adenoma detection in some but not other studies. Most previous studies have been limited by small sample sizes and few participating endoscopists. The aim of the current study was to evaluate whether cap-assisted colonoscopy improves adenoma detection in a two-center, multi-endoscopist, randomized trial. Consecutive patients who presented for an elective colonoscopy were randomized to cap-assisted colonoscopy (4-mm cap) or standard colonoscopy performed by one of 10 experienced endoscopists. Primary outcome measures were mean number of adenomas per patient and adenoma detection rate (ADR). Secondary outcomes included procedural measures and endoscopist variation; a logistic regression model was employed to examine predictors of increased detection with cap use. A total of 1113 patients (64 % male, mean age 62 years) were randomized to cap-assisted (n = 561) or standard (n = 552) colonoscopy. The mean number of adenomas detected per patient in the cap-assisted and standard groups was similar (0.89 vs. 0.82; P = 0.432), as was the ADR (42 % vs. 40 %; P = 0.452). Cap-assisted colonoscopy achieved a faster cecal intubation time (4.9 vs. 5.8 minutes; P < 0.001), a similar cecal intubation rate (99 % vs. 98 %; P = 0.326), and a higher terminal ileum intubation rate (93 % vs. 89 %; P < 0.028). Cap-assisted colonoscopy resulted in a 20 % increase in ADR for some endoscopists and in a 15 % decrease for others. Individual preference for the cap was an independent predictor of increased adenoma detection in adjusted analysis (P < 0.001), whereas baseline low adenoma detection was not. Although the efficiency of cecal and terminal ileum intubation was slightly improved by cap-assisted colonoscopy, adenoma detection was not. Cap-assisted colonoscopy may be beneficial for selected endoscopists. clinicalTrials.gov (NCT01935180).