Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial

• Published in: Gut Vol. 61; no. 3; pp. 402 - 408
• Main Authors: Rastogi, Amit, Bansal, Ajay, Rao, Deepthi S, Gupta, Neil, Wani, Sachin B, Shipe, Tracy, Gaddam, Srinivas, Singh, Vikas, Sharma, Prateek
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.03.2012; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: adenocarcinoma; adenoma; Adenoma - diagnosis; Adenoma - pathology; Aged; Barrett's carcinoma; Barrett's metaplasia; Barrett's oesophagus; Biological and medical sciences; colonic adenomas; Colonoscopes - adverse effects; Colonoscopy; Colonoscopy - adverse effects; Colonoscopy - methods; Colorectal cancer; colorectal cancer screening; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - pathology; cost-effectiveness; decision analysis; Digestive system. Abdomen; Early Detection of Cancer - instrumentation; Early Detection of Cancer - methods; Endoscopy; Female; gastro-oesophageal reflux disease; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Intubation; Investigative techniques, diagnostic techniques (general aspects); low-grade dysplasia; Male; Medical sciences; Medical screening; Middle Aged; Population Surveillance - methods; Prospective Studies; Studies; Surveillance; Time Factors; Tumors; Benign neoplasm; Adenoma; Endoscopy; Colonoscopy; Gastroenterology
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gutjnl-2011-300187

ObjectiveCap-assisted colonoscopy (CAC) uses a small plastic transparent cap attached to the tip of the colonoscope that can depress and flatten colonic folds and thus improve visualisation of their proximal aspects. The aim of this study was to compare CAC with standard colonoscopy (SC; high-definition white light) for adenoma detection rates.DesignThis is a prospective randomised controlled trial.SettingThe study was performed in a tertiary-care Veterans Affairs Medical Center in the USA.PatientsSubjects undergoing screening or surveillance colonoscopy were enrolled.InterventionsSubjects were randomised to undergo either CAC or SC.Main outcome measuresThe outcome measures were the proportion of subjects with at least one adenoma, the number of adenomas detected per subject, insertion time, caecal intubation rates and complications.Results420 subjects were enrolled and included in the study (210 in each group). The proportion of subjects with at least one adenoma was higher with CAC compared to SC (69% vs 56%, p=0.009). CAC also detected a higher number of adenomas per subject (2.3 vs 1.4, p<0.001). The caecal intubation time was shorter with CAC (3.29 min vs 3.98 min, p<0.001). The caecal intubation rates were similar in the two groups (99% vs 98%, p=0.37). There were no complications associated with CAC or SC.ConclusionsCAC detected a 13% higher number of subjects with at least one adenoma and 59% higher adenomas per subject. CAC is a safe, effective and practical means to improve adenoma detection rates.Clinical Trial RegistrationNCT 01211132.