title: Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial.
abstract: OBJECTIVE
  Cap-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.
  
  
  METHODS
  This is a prospective randomised controlled trial.
  
  
  METHODS
  The study was performed in a tertiary-care Veterans Affairs Medical Center in the USA.
  
  
  METHODS
  Subjects undergoing screening or surveillance colonoscopy were enrolled.
  
  
  METHODS
  Subjects were randomised to undergo either CAC or SC.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  420 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.
  
  
  CONCLUSIONS
  CAC 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.
  
  
  BACKGROUND
  NCT 01211132.
authors: Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA. amitr68@hotmail.com
authors: Amit
authors: A
authors: Rastogi
authors: Ajay
authors: A
authors: Bansal
authors: Deepthi S
authors: DS
authors: Rao
authors: Neil
authors: N
authors: Gupta
authors: Sachin B
authors: SB
authors: Wani
authors: Tracy
authors: T
authors: Shipe
authors: Srinivas
authors: S
authors: Gaddam
authors: Vikas
authors: V
authors: Singh
authors: Prateek
authors: P
authors: Sharma
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D020685:Colonoscopes / Q000009:adverse effects; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors