Usefulness of cap-assisted colonoscopy during colonoscopic EMR: a randomized, controlled trial

BackgroundClinical demand for total colonoscopy is increasing. Several articles have reported on the usefulness of a cap for faster cecal intubation and reduced patient discomfort, but results for polyp and adenoma detection have been inconsistent.ObjectiveTo assess the efficacy of a cap attached to the tip of a colonoscope for detection and resection of polyps by experienced colonoscopists.DesignProspective, randomized, controlled trial.SettingA tertiary referral center.Patients and InterventionA total of 329 patients who underwent colonoscopic EMR were randomized to cap-assisted colonoscopy (CAC) (CAC group, n = 166) or regular colonoscopy (RC) (RC group, n = 163).Main Outcome MeasurementsCecal intubation time, total procedure time, required time for colonoscopic EMR of each polyp, and missing polyp rate.ResultsThe cecal intubation time in the CAC group and RC group was 5.3 ± 3.3 minutes and 5.8 ± 3.7 minutes, respectively (P = .170). The total procedure time in the CAC group and RC group was 23.0 ± 15.5 minutes and 29.2 ± 13.4 minutes, respectively (P = .626). The time required for colonoscopic EMR of each polyp in the CAC group and RC group was 3.5 ± 4.5 minutes and 4.2 ± 5.1 minutes, respectively (P = .010). The number of polyps during the initial colonoscopy in the CAC group and RC group was 2.2 ± 1.7 and 2.0 ± 1.8, respectively (P = .221). The number of detected polyps during colonoscopic EMR in the CAC group and RC group was 3.4 ± 2.7 and 2.7 ± 1.9 (P = .003). The number of missed polyps in the CAC group and RC group was 1.1 ± 1.5 and 0.8 ± 0.9 (P = .024).LimitationSingle-center experience.ConclusionsCAC may reduce the time required for colonoscopic EMR of each polyp and may also improve the polyp detection rate.