Prospective randomized controlled trial evaluating cap-assisted colonoscopy vs standard colonoscopy.
OBJECTIVE
To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate.


METHODS
This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study.


RESULTS
There were 200 cases in each group. There was no significant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no significant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 +/- 7.05 min vs 10.34 +/- 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 +/- 13.95 min vs 22.56 +/- 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003), trainee-performed procedures (P = 0.01), usage of hyoscine (P = 0.01) and procedures performed for polyp follow-up (P = 0.01). The limitations of the study were that it was a single-center experience, no blinding was possible, and there were a large number of endoscopists.


CONCLUSIONS
CAC did not significantly different from SC in term of cecal intubation time and polyp detection rate.
Tee
Hoi-Poh
HP
Gastroenterology Unit, Medical Department, Hospital Tengku Ampuan Afzan, Jalan Tanah Putih, Kuantan, Pahang, Malaysia. drhptee@gmail.com
Corte
Crispin
C
Al-Ghamdi
Hamdan
H
Prakoso
Emilia
E
Darke
John
J
Chettiar
Raman
R
Rahman
Wassim
W
Davison
Scott
S
Griffin
Sean-P
SP
Selby
Warwick-S
WS
Kaffes
Arthur-J
AJ
D000328:Adult; D000368:Aged; D002400:Cathartics / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003111:Colonic Polyps / Q000175:diagnosis*; D020685:Colonoscopes; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D009517:New South Wales; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012601:Scopolamine / Q000627:therapeutic use; D012737:Sex Factors; D013997:Time Factors
D002400:Cathartics; D018727:Muscarinic Antagonists; D012601:Scopolamine