title: Cap assisted colonoscopy for the detection of serrated polyps: a post-hoc analysis.
abstract: BACKGROUND
  Colonoscopy offers limited protection against right-sided colon cancer, a significant proportion of which arise from the serrated pathway of carcinogenesis. The aim of this study was to compare cap-assisted colonoscopy and standard high-definition white light colonoscopy regarding serrated polyps' detection.
  
  
  METHODS
  Post hoc analysis was performed of a previously conducted randomized controlled trial comparing standard and cap-assisted colonoscopy for adenoma detection. Randomization was stratified based on the indication of colonoscopy and all procedures were performed by three experienced endoscopists. Following cecal intubation, the colonic mucosa was carefully inspected during withdrawal of colonoscope and all polyps detected were documented for their size, location, morphology and then removed and sent for histopathology. Detection rates of significant serrated polyps between both arms were compared using the Fisher's exact test and Wilcoxon Rank Sum test.
  
  
  RESULTS
  427 patients were enrolled (7 exclusions, 210 completed study in each arm, mean age of 61 years, 95% male, 75% Caucasian, 67% screening colonoscopies). There were no significant differences in baseline characteristics between both groups. Cap-assisted colonoscopy detected a significantly higher proportion of subjects with significant serrated polyps as well as a higher total number of significant serrated polyps compared to standard colonoscopy (12.8% vs. 6.6%, p =0.047 and 40 vs. 20,p = 0.03 respectively).
  
  
  CONCLUSIONS
  In this post-hoc analysis, Cap-assisted colonoscopy is a safe technique that offers a higher detection rate of significant serrated polyps when compared to standard colonoscopy. If confirmed in future trials, this simple technique has the potential to improve protection against interval colon cancers.
authors: Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, 66160, USA. frzouq@kumc.edu.
authors: Fadi
authors: F
authors: Rzouq
authors: Department of Gastroenterology, Loyola University Medical Center, Maywood, IL, 60153, USA. ngupta713@gmail.com.
authors: Neil
authors: N
authors: Gupta
authors: Department of Gastroenterology, University of Colorado and Veterans Affairs Medical Center, Aurora, CO, 80045, USA. sachin.wani@ucdenver.edu.
authors: Sachin
authors: S
authors: Wani
authors: Department of Gastroenterology, University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, MO, 64128, USA. psharma@kumc.edu.
authors: Prateek
authors: P
authors: Sharma
authors: Department of Gastroenterology, University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, MO, 64128, USA. abansal@kumc.edu.
authors: Ajay
authors: A
authors: Bansal
authors: Department of Gastroenterology, University of Kansas School of Medicine, Kansas City Veterans Affairs Medical Center, Kansas City, MO, 64128, USA. arastogi@kumc.edu.
authors: Amit
authors: A
authors: Rastogi
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003111:Colonic Polyps / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods*; D055088:Early Detection of Cancer / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
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