The Efficacy of Cap-Assisted Colonoscopy in Polyp Detection and Cecal Intubation: A Meta-Analysis of Randomized Controlled Trials

Ng, Siew C.; Tsoi, Kelvin K.F.; Hirai, Hoyee W.; Lee, Yuk Tong; Wu, Justin Che Yuen; Sung, Joseph J.Y.; Chan, Francis K.L.; Lau, James Y.

doi:10.1038/ajg.2012.135

Cited by 134 publications

(90 citation statements)

References 37 publications

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“…Adenoma detection has been shown to be an independent predictor of the risk of interval colorectal cancer after screening colonoscopy [5]. Several types of new technology have therefore been developed to improve adenoma detection, including high-definition white-light colonoscopy, pan-chromoendoscopy, wide-angle colonoscopy, virtual chromoendoscopy, third-eye retroscopy (TER), and cap-assisted colonoscopy (CAC) [6].CAC is a simple method in which a transparent or nontransparent rubber cap is attached to the tip of a colonoscope with an appropriate protrusion length. The cap can be readily equipped and the field of vision is not substantially affected by the cap.…”

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“…CAC can help depress semilunar folds, thereby reducing the blind mucosal surface area, and may improve the efficiency of adenoma detection [6]. A study of lesions missed at colonoscopy but detected by computed tomography colonography revealed that 67 % lie on the proximal side of semilunar folds [11].…”

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“…CAC seeks to reduce the percentage of the colonic mucosal surface that is left unexamined in a ''complete'' colonoscopy [12]. Largescale meta-analyses have revealed that CAC improves the detection of colonic neoplasm compared with standard colonoscopy (SC) both in terms of the number of patients identified with at least one polyp and in terms of the polyp miss rate determined by tandem colonoscopy [6,13]. It seems that CAC predominantly improves the detection of small (6-9 mm) and diminutive (5 mm) adenomas.…”

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“…It has been speculated that less-experienced operators would obtain greater benefit from such a device [10]. Expert endoscopists have been shown to have a shorter cecal intubation time with CAC than SC [6]. A randomized controlled trial reported that the successful intubation rate for CAC was 67 versus 21 % for SC in failed colonoscopy [19].…”

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Can Cap-Assisted Colonoscopy Be a Savior for Right Side Interval Cancer?

Kim

2012

Dig Dis Sci

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There is no doubt that effective colorectal cancer screening relies on early identification and removal of polyps with neoplastic potential [1,2]. Although colonoscopy is regarded as the best method for detecting colonic neoplasm, it does have limitations. Right-sided lesions, flat polyps, and variable detection of endoscopist adenoma are all reasons why polyps are missed and interval cancers develop after a negative screening colonoscopy. Successful colorectal cancer protection by colonoscopy depends on complete intubation of the colon combined with careful and complete visualization of the colonic mucosal surface on withdrawal. A large populationbased study showed that failure to intubate the cecum is not uncommon, especially for less experienced endoscopists; it was estimated to occur in 13.1 % of attempted colonoscopies [3]. Furthermore, occurrence of missed adenoma ranging from 13 to 26 % has been reported [4]. Adenoma detection has been shown to be an independent predictor of the risk of interval colorectal cancer after screening colonoscopy [5]. Several types of new technology have therefore been developed to improve adenoma detection, including high-definition white-light colonoscopy, pan-chromoendoscopy, wide-angle colonoscopy, virtual chromoendoscopy, third-eye retroscopy (TER), and cap-assisted colonoscopy (CAC) [6].CAC is a simple method in which a transparent or nontransparent rubber cap is attached to the tip of a colonoscope with an appropriate protrusion length. The cap can be readily equipped and the field of vision is not substantially affected by the cap. Although conflicting results have been reported after recent studies that compared CAC with standard colonoscopy (SC), CAC has been reported to be associated with improved polyp detection, reduced cecal intubation time, and enhanced cecal intubation [7][8][9][10].Theoretically, CAC can detect polyps better than SC, especially those behind semilunar folds. CAC can help depress semilunar folds, thereby reducing the blind mucosal surface area, and may improve the efficiency of adenoma detection [6]. A study of lesions missed at colonoscopy but detected by computed tomography colonography revealed that 67 % lie on the proximal side of semilunar folds [11]. The cap also keeps the tip of the endoscope a distance from the colonic mucosa, particularly around colonic bends, and provides a continuous visual field of the lumen direction. CAC seeks to reduce the percentage of the colonic mucosal surface that is left unexamined in a ''complete'' colonoscopy [12]. Largescale meta-analyses have revealed that CAC improves the detection of colonic neoplasm compared with standard colonoscopy (SC) both in terms of the number of patients identified with at least one polyp and in terms of the polyp miss rate determined by tandem colonoscopy [6,13]. It seems that CAC predominantly improves the detection of small (6-9 mm) and diminutive (5 mm) adenomas. A study of colonoscopic miss rates determined by back-toback colonoscopies revealed the miss rate was 13 % for sm...

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