title: Adenoma detection with cap-assisted colonoscopy versus regular colonoscopy: a randomised controlled trial.
abstract: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology & Hepatology , Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: de Wijkerslooth
authors.forename: Esther M
authors.initials: EM
authors.lastname: Stoop
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Elisabeth M H
authors.initials: EM
authors.lastname: Mathus-Vliegen
authors.forename: Jan
authors.initials: J
authors.lastname: Dees
authors.forename: Kristien M A J
authors.initials: KM
authors.lastname: Tytgat
authors.forename: Monique E
authors.initials: ME
authors.lastname: van Leerdam
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D013997:Time Factors