Benefit of “transparent soft-short-hood on the scope” for colonoscopy among experienced gastroenterologists and gastroenterologist trainee: a randomized, controlled trial

Abstract

BackgroundThe attachment of a transparent hood to the colonoscope tip has been reported to offer some benefits, such as enabling the endoscopist to perform the colonoscopy more easily and to save time. However, there have been no randomized, controlled trials concerning these benefits, nor have any reports been published regarding the use of hoods for the purpose of training colonoscopists. Therefore, we conducted this study to evaluate the possible benefits of the transparent soft short hood when used by both experienced and trainee endoscopist groups.MethodsThis randomized, controlled trial to assess the results of using a transparent soft short hood attached to the tip of the colonoscope was undertaken by two groups of investigators: experienced endoscopists and gastroenterologist trainees. The cecal and ileal intubation times, as well as the doses of sedative medication required, were analyzed.ResultsA total of 112 patients, 65 of whom were female, underwent colonoscopy by 2 endoscopists and 5 gastroenterologist trainees. Colonoscopy was complete in 100% of the patients. The study showed significant shortening of the cecal intubation time when using the soft short hood, in both the endoscopist and gastroenterologist trainee groups (6.8/4.61 min, P = 0.006; and 9.36/7.36 min, P = 0.03). The ileal intubation time had a trend to be significantly less when using the transparent hood in the trainee group (126.4/52.9 s), although this was not statistically significant (P = 0.08). The average dose of propofol, when using the transparent hood, was significantly lower in the endoscopist group (180/120 mg, P = 0.001). No significant complications occurred in the hood or non-hood groups.ConclusionsThe transparent soft short hood shortened the cecal intubation time in both the experienced endoscopist and gastroenterologist trainee groups, as well as reducing the dose of sedative medication required in the experienced endoscopist group. Interestingly, it also reduced the trainee ileal intubation time. The attachment of this type of hood enabled both the experienced endoscopists and gastroenterological trainees to perform colonoscopy more quickly and easily, without any complications.

Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection: A Network Meta-analysis

“…All 25 RCTs were 2-arm controlled trials, in which 14 compared Cap-assisted colonoscopy with SC, 21-34 9 compared Endocuff with SC, 35-43 1 compared Endorings with SC, 44 and 1 compared Endocuff with Cap. 45 The PDR was reported in all included trials, the ADR was registered in 20 RCTs, 22,[24][25][26][28][29][30]32,33,[35][36][37][38][39][40][41][42][43][44][45] the cecal intubation rate in 16 RCTs, 22,23,[25][26][27][28][29][30][31][32][33][34]37,40,43,45 and cecal intubation time in 17 RCTs. [21][22][23][24][25][26][28][29][30]32,34,…”

“…21,23,26,27,31,33,34 Quality assessment was performed in the context of the primary outcome, and overall the studies were believed to be at moderate risk of bias, mainly owing to performance and detection bias related to the unblinded design of the included RCTs. Six abstracts 35,36,38,41,42,45 and 5 full-text reports 21,23,27,31,34 were considered at higher risk of bias because of incomplete outcome reporting. Overall and study-level quality assessments are summarized in Supplementary Figure 1A and B, respectively.…”

“…Data on the comparison between distal attachment devices and SC in terms of cecal intubation rate was available in 15 RCTs 22,23,[25][26][27][28][29][30][31][32][33][34]37,40,43,45 (10,110 patients). The 2 groups results were perfectly comparable (RR, 1.00; 95% CI, 1.00-1.00; P ¼ .71), with no evidence of heterogeneity (I 2 ¼ 0%).…”

“…(B) Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. 16% patients with "more than two episodes of discomfort" 21% patients with "more than two episodes of discomfort" 1 postpolypectomy bleeding and 1 perforation 30 Not reported Not reported Prachayakul, 2012 31 Not reported Not reported Rastogi 2011 32 None None Takeuchi 2010 33 Minor bleeding in 3 patients Minor bleeding in 1 patient Tee 2010 34 Minor bleeding in 1 patient Minor bleeding in 1 patient Endocuff vs standard colonoscopy Ngu 2017 35 Procedure uncomfortable in 23.6% patients vs 15.0% Procedure uncomfortable in 15% patients Bhattacharyya 2016 36 None None Biecker 2015 37 None None Catalano 2017 38 Not reported Not reported De Palma 2017 39 Minor bleeding in 7 (2.5%) patients None Floer 2014 40 None None Garcia 2016 41 None None Hass 2016 42 Minor bleeding in 8.3% of patients None Van Doorn 2017 43 A case of deep venous thrombosis Minor bleeding in 2 patients A case of perianal abscess Endorings vs standard colonoscopy Dik 2015 44 None None Endocuff vs Cap Yamaoka 2017 45 Not reported Not reported…”

The endoscopic cap that can (with videos)

“…Thirteen other groups have since published their results since that time. [7][8][9][10][11][12]14,17,[24][25][26]29,30 The more recent studies have primarily focused on its potential use to increase the adenoma detection rate.…”