Cap-assisted gastroscope versus cap-assisted colonoscope for examination of difficult sigmoid colons in a nonsedated Asian population: a randomized study

BackgroundStudies have estimated that cecal intubation failure occurs with conventional colonoscopy in about 10% of cases. Various methods have been adopted to improve the cecal intubation rate, including a transparent cap and special colonoscopes.ObjectiveTo assess the efficacy of using a cap-assisted gastroscope (E-cap) compared with a cap-assisted colonoscope (C-cap) for the complete examination of the colon in nonsedated patients with technically difficult sigmoid colons.DesignRandomized, controlled study.SettingTertiary-care referral center.PatientsOne hundred thirty-nine patients with technically difficult sigmoid colons were studied.InterventionColonoscopy with either an E-cap (n = 69) or a C-cap (n = 70).Main Outcome MeasurementsCecal intubation rate, cecal intubation time, patient-assessed pain score, and endoscopist-assessed pain score.ResultsThe cecal intubation rate was significantly higher in the E-cap (65/69, 94.2%) than in the C-cap group (50/70, 71.4%; P < .0001). Patient-assessed pain (moderate to severe) was more frequently reported in the C-cap (14/70, 20.0%) than in the E-cap group (5/69, 7.2%; P = .029). Endoscopist-assessed pain (moderate to severe) was more frequently reported in the C-cap (13/70, 18.6%) than in the E-cap group (3/69, 7.2%; P = .009). For patients with a low body mass index (≤22 kg/m2), the cecal intubation rate was significantly higher in the E-cap (37/38, 97.4%) than in the C-cap group (15/29, 51.7%; P < .0001).LimitationsSingle-center experience, lack of a gastroscope control group without a cap.ConclusionThe cap-assisted gastroscope is more tolerable and effective than cap-assisted colonoscope for the complete examination of the colon in patients with technically difficult sigmoid colons. (Clinical trial registration number: KCT0000744.)