The efficacy of cap-assisted colonoscopy in polyp detection and cecal intubation: a meta-analysis of randomized controlled trials.
OBJECTIVE
The role of cap-assisted colonoscopy (CAC) in polyp detection and cecal intubation is unclear. We conducted a meta-analysis to compare the efficacy of CAC vs. standard colonoscopy (SC).


METHODS
Publications in English and non-English literatures (OVID, MEDLINE, and EMBASE) and abstracts in major international conferences were searched for controlled trials comparing CAC and SC. Outcome measures included the proportion of patients with polyps or adenomas detected, cecal intubation rate, cecal intubation time, and total colonoscopy time. The statistical heterogeneity of trials was examined and the effects were pooled by random-effects model. The risk of bias was evaluated by the assessment tool from the Cochrane Handbook. Subgroup analyses were performed for possible clinical and methodological heterogeneities.


RESULTS
From 2,358 citations, 16 randomized controlled clinical trials were included consisting of 8,991 subjects (CAC: 4,501; SC: 4,490). Mean age of subjects was 61.0 years old and 60% were males. CAC detected a higher proportion of patients with polyp(s) (relative risk (RR): 1.08; 95% confidence interval (CI): 1.00-1.17) and reduced the cecal intubation time (mean difference: -0.64 min; 95% CI: -1.19 to -0.10). Cecal intubation rate (RR: 1.00; 95% CI: 0.99-1.02) and total colonoscopy time (mean difference: -0.97 min; 95% CI: -2.33 to 0.40) were comparable between the two groups. In subgroup analyses, a short cap (≤4 mm) was associated with improved polyp detection, whereas a long cap (≥7 mm) was associated with a shorter cecal intubation time.


CONCLUSIONS
CAC demonstrated marginal benefit over SC for polyp detection and shortened the cecal intubation time.
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong. siewchienng@cuhk.edu.hk
Siew C
SC
Ng
Kelvin K F
KK
Tsoi
Hoyee W
HW
Hirai
Yuk Tong
YT
Lee
Justin C Y
JC
Wu
Joseph J Y
JJ
Sung
Francis K L
FK
Chan
James Y W
JY
Lau
D000236:Adenoma / Q000175:diagnosis*; D002432:Cecum / Q000473:pathology*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis*; D020685:Colonoscopes; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007440:Intubation; D016032:Randomized Controlled Trials as Topic