Journal Article

Adenoma detection with cap-assisted colonoscopy versus regular colonoscopy: a randomised controlled trial

Bossuyt, Patrick M, Stoop, Esther M, de Wijkerslooth, Thomas R, Dees, Jan, van Leerdam, Monique E, Dekker, Evelien, Tytgat, Kristien M A J, Fockens, Paul, Mathus-Vliegen, Elisabeth M H, Kuipers, Ernst J

2012

Overview

Objective Conventional colonoscopy (CC) is considered the reference standard for detection of colorectal neoplasia, but it can still miss a substantial number of adenomas. The use of a transparent plastic cap may improve colonic visualisation. Cap-assisted colonoscopy (CAC) was compared with CC for adenoma detection. Secondary outcomes were caecal intubation time, caecal intubation rate and the degree of discomfort of colonoscopy. Design This is a parallel, randomised, controlled trial at two centres. Asymptomatic participants (aged 50–75 years) in a primary colonoscopy screening programme were consecutively invited. Consenting subjects were 1:1 randomised to either CAC or CC. All colonoscopies were performed by experienced endoscopists (≥1000 colonoscopies) who were trained in CAC. Colonoscopy quality indicators were prospectively recorded. Results A total of 1380 participants were randomly allocated to CC (N=694) or CAC (N=686). Caecal intubation rate was comparable in the two groups (98% vs 99%; p=0.29). Caecal intubation time was significantly lower in the CAC group: 7.7±5.0 min with CAC vs 8.9±6.2 min with CC (p<0.001) (values mean±SD). Adenoma detection rates of all endoscopists were ≥20%. The proportion of subjects with at least one adenoma was similar in the two groups (28% vs 28%; RR 0.98; 95% CI 0.82 to 1.16), as well as the mean number of adenomas per subject (0.49±1.05 vs 0.50±1.03; p=0.91). Detection of small size, flat and proximally located adenomas was comparable. CAC participants had lower Gloucester Comfort Scores during colonoscopy (2.2±1.0 vs 2.0±1.0; p=0.03). Conclusion CAC does not improve adenoma detection, but does reduce caecal intubation time by more than 1 min and does lessen the degree of discomfort during colonoscopy.

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group,BMJ Publishing Group LTD
• Subject: Adenoma / Adenoma - diagnosis / advanced endoscopic imaging / Aged / barretts carcinoma / barretts oesophagus / Biological and medical sciences / cap / Clinical medicine / Colonic Neoplasms - diagnosis / colonoscopy / Colonoscopy - instrumentation / Colonoscopy - methods / Colonoscopy - standards / Colorectal cancer / colorectal carcinoma / CRC surveillance / Digestive system. Abdomen / Early Detection of Cancer / endoscopic polypectomy / endoscopic procedures / endoscopic sphincterotomy / endoscopic ultrasonography / Endoscopy / familial adenomatous polyposis / family cancer / Female / gastric cancer / gastritis / gastro-oesophageal reflux disease / Gastroenterology. Liver. Pancreas. Abdomen / gastrointesinal endoscopy / gastrointestinal bleeding / Helicobacter pylori / hood / Humans / IBD / Intubation / Investigative techniques, diagnostic techniques (general aspects) / laser / Male / Medical sciences / Medical screening / Middle Aged / narrow band imaging / Outcome Assessment (Health Care) / pancreato-biliary disorders / Patient Satisfaction - statistics & numerical data / Quality Indicators, Health Care / R&D / randomised trial / Research & development / screening / Studies / Time Factors / Tumors