Background: The efficacy of cap-assisted and water-exchange colonoscopy for adenoma detection, individually or in combination, is well documented but the efficacy of the combination colonoscopy using the above methods with prone position for adenoma detection is unclear. We compared the effectiveness of the combination colonoscopy using modified cap-assisted and water-exchange colonoscopy with prone position (CWP) and conventional colonoscopy (CC) for adenoma detection.Methods: A total of 746 patients who underwent either CWP or CC, performed by two board-certified gastroenterologists between December 2019 and March 2020, were investigated retrospectively. Cap-assisted colonoscopy was modified using hooking and dragging maneuver. We evaluated the polyp detection rate (PDR), adenoma detection rate (ADR), and mean number of adenomas detected per procedure (MAP). Results: There was no significant difference in sex, age, the indication of colonoscopy and quality of bowel preparation between the two groups. The PDR, ADR, and proximal MAP were significantly higher in the CWP group than the CC group (PDR: 84.9% vs. 59.8%, P < 0.001; ADR: 70.1%, vs. 49.2%, P < 0.001; proximal MAP: 1.24 vs. 0.55, P < 0.001). Amongst males, total and proximal MAP were significantly higher in the CWP group than the CC group, respectively (2.28 ± 2.24 vs. 1.49 ± 1.92, P < 0.001; 1.73 ± 1.98 vs. 0.74 ± 1.21, P < 0.001). Conclusions: Combination colonoscopy is more effective than conventional colonoscopy for the PDR, ADR, and proximal MAP. Further studies assessing the synergistic or complementary effects of the combination are needed.

The efficacy of cap-assisted and water-exchange colonoscopy, individually or in combination for adenoma detection is well documented. Moreover, prone positioning colonoscopy may also improve adenoma detection by decreasing loop formation. However, the efficacy of triple-combination colonoscopy using the above methods for adenoma detection is unclear. This study aimed to compare the effectiveness of combining modified cap-assisted and water-exchange colonoscopy with prone position (CWP) and conventional colonoscopy (CC) for adenoma detection.A total of 746 patients who underwent either CWP or CC, performed by 2 board-certified gastroenterologists between December 2019 and March 2020, were investigated retrospectively. Cap-assisted colonoscopy was modified using hooking and dragging maneuver. We evaluated the polyp detection rate (PDR), adenoma detection rate (ADR), and the mean number of adenomas detected per procedure (MAP).There was no significant difference in sex, age, the indication of colonoscopy and quality of bowel preparation between the 2 groups. PDR, ADR, and proximal colon MAP were significantly higher in the CWP group than in the CC group (PDR: 84.9% vs 59.8%, P < .01; ADR: 70.1%, vs 49.2%, P < .01; proximal colon MAP: 1.24 vs 0.55, P < .01).CWP is more effective than CC for PDR, ADR, and proximal colon MAP. Although it may facilitate adenoma detection, further studies assessing the synergistic or complementary effects of combining these methods are needed.Abbreviations: ADR = adenoma detection rate, CC = conventional colonoscopy, CWP = combining modified cap-assisted and water-exchange colonoscopy with prone position, FOBT = fecal occult blood test, MAP = mean number of adenomas detected per procedure, PDR = polyp detection rate.

Background: The efficacy of cap-assisted, water-aided, and 12 o'clock-prone position colonoscopy as individual techniques for adenoma detection is well documented. However, the efficacy of the combination of the three colonoscopy methods is unclear. Therefore, the present study aimed to retrospectively compare the efficacy between combined-method colonoscopy (CMC) and standard colonoscopy (SC). Methods and Findings: A total of 746 patients who underwent either CMC or SC, performed by two board-certified gastroenterologists between December 2019 and March 2020 at Baekyang Jeil Internal Medicine Clinic, were retrospectively evaluated. We evaluated polyp detection rate (PDR), adenoma detection rate (ADR), and mean number of adenomas detected per procedure (MAP). Statistical analysis for comparison between the groups was performed using the Student's t-test, and ADR and PDR were analyzed using Fisher's exact test. The study population was predominantly women (55.4%). The mean patient age (standard deviation) was 62.87 (±7.83) years. There was no significant difference in sex, number of fecal occult blood test-positive patients, and age between the two groups. The PDR, ADR, and proximal colon MAP were significantly higher in the CMC group than in the SC group (PDR: 59.8% vs. 84.9%, p < 0.001; ADR: 49.2% vs. 70.1%, p < 0.001; proximal colon MAP: 0.55 vs. 1.24, p < 0.001). Conclusions: Compared with SC, CMC increases PDR, ADR, and MAP, especially proximal colon MAP. Therefore, CMC may be more useful than SC in clinical settings. This study is the first to evaluate the efficacy of the three techniques in combination.