Transparent cap-assisted colonoscopy versus standard adult colonoscopy: a systematic review and meta-analysis.
BACKGROUND
Cap-assisted colonoscopy uses a transparent plastic hood attached to the tip of the colonoscope to flatten the semilunar folds and improve mucosal exposure. Several studies have examined the effect of cap-assisted colonoscopy on polyp detection, but the data are inconsistent.


OBJECTIVE
This study aimed to evaluate whether cap-assisted colonoscopy improves the yield of colorectal neoplasia detected compared with standard colonoscopy.


METHODS
A systematic search of the PubMed, MEDLINE, Embase, and Cochrane databases identified 12 studies that met the inclusion criteria for data extraction.


METHODS
Publications that compared cap-assisted colonoscopy vs standard colonoscopy in adults in a prospective randomized controlled study were selected for review.


METHODS
The primary outcomes used for meta-analysis were cecal intubation rate, cecal intubation time, and polyp detection rate. The analysis was performed using a fixed-effect model. Outcomes were calculated as odds ratios or standardized mean differences with 95% confidence intervals. The average polyp miss rate determined by tandem colonoscopy was also calculated.


RESULTS
The outcomes of 6185 patients were studied. Cap-assisted colonoscopy detected significantly more patients with polyps (OR 1.13; p = 0.030) and had a lower average polyp miss rate (12.2% vs 28.6%) than standard colonoscopy. Cap-assisted colonoscopy had a significantly higher cecal intubation rate than standard colonoscopy (OR 1.36; p = 0.020), whereas the time to cecal intubation (standard mean difference, 0.04 min; p = 0.280) was similar for the 2 colonoscope types.


CONCLUSIONS
Cap-assisted colonoscopy is associated with improved detection of colorectal neoplasia and higher cecal intubation rates than standard adult colonoscopy.
Department of Surgery, Christchurch Hospital, Christchurch, New Zealand. d.westwood@doctors.net.uk
David A
DA
Westwood
Nicholas
N
Alexakis
Saxon J
SJ
Connor
D000328:Adult; D003111:Colonic Polyps / Q000175:diagnosis*; D020685:Colonoscopes; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D006801:Humans; D007441:Intubation, Gastrointestinal