Randomized control trial of adenoma detection rate in Endocuff-assisted colonoscopy versus transparent hood-assisted colonoscopy.
Imaeda Hiroyuki,Yamaoka Minoru,Ohgo Hideki,Soma Hiromitsu,Ashitani Keigo,Miyaguchi Kazuya,Tsuzuki Yoshikazu,Hosoe Naoki,Nakamoto Hidetomo
Journal of gastroenterology and hepatology
BACKGROUND AND AIM:Transparent hood-assisted colonoscopy (TAC) has been reported to improve the cecal insertion rate and adenoma detection rate (ADR). An endoscopic cap (Endocuff) with two rows of soft wings was recently developed to improve ADR, by flattening the mucosal folds during withdrawal. This randomized prospective control study aimed to compare ADR between Endocuff-assisted colonoscopy (EAC) and TAC. METHODS:A total of 513 patients undergoing colon adenoma screening were included. EAC was performed in 256 patients and TAC in 260 patients. Cecal intubation rate, cecal intubation time, ADR, and mean adenoma number per patient (MAP) were investigated in both groups (clinical trial registration: UMIN000016278). RESULTS:We excluded six patients in the EAC group and two patients in the TAC group because of colonic stenosis due to colonic adenocarcinomas. Finally, 250 patients (151 men/99 women, median age 62.1 years) were assigned to EAC and 258 patients (165 men/93 women, median age 64.3 years) were assigned to TAC. There were no significant differences in cecal intubation rate, intubation time, withdrawal time, and cleanliness score between groups. The ADR was 50.8% in EAC and 52.7% in TAC, with no significant difference (P = 0.666). The MAP was 1.35 in EAC and 1.20 in TAC, with no significant difference (P = 0.126). However, The MAP of diminutive adenomas (< 5 mm) tended to be higher in EAC than in TAC (P = 0.077). There was no significant difference in MAP in each segment between groups. CONCLUSIONS:Endocuff-assisted colonoscopy might be equivalent to TAC in cecal intubation time, ADR, and MAP.
10.1111/jgh.14771
Prospective and randomized study to evaluate the clinical impact of cap assisted colonoscopy (CAC).
Frieling T,Neuhaus F,Kuhlbusch-Zicklam R,Heise J,Kreysel C,Hülsdonk A,Blank M,Czypull M
Zeitschrift fur Gastroenterologie
BACKGROUND:Although colonoscopy is the standard procedure in the diagnosis of colorectal neoplasia, a significant number of clinical relevant lesions may be missed even by experienced endoscopists using current technology. A transparent cap mounted at the tip of a colonoscope may be an easy way to extend the visual field during colonoscopy and may improve the detection rate of mucosal lesions. MATERIAL AND METHODS:The significance of cap assisted (CAC) vs. conventional colonoscopy (CC) on polyp detection rate was evaluated in a prospective randomized controlled trial in 504 patients. RESULTS:CC and CAC detected polyps in 39.3 % and 31.8, not significantly different. There was also no significant difference between CAC and CC according to age, sex, indication for colonoscopy, diverticulosis, sedation, bowel cleansing, withdrawal time, time/number of attempts to intubate the cecal walve, number, localization, size or histology of polyps,. However, the time to reach the cecal floor and the overall time of colonoscopy were significantly lower for CAC (1 minute). CONCLUSION:CAC was without clinical impact on polyp detection rate or performance of colonoscopy.
10.1055/s-0033-1335637
Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial.
Rastogi Amit,Bansal Ajay,Rao Deepthi S,Gupta Neil,Wani Sachin B,Shipe Tracy,Gaddam Srinivas,Singh Vikas,Sharma Prateek
Gut
OBJECTIVE:Cap-assisted colonoscopy (CAC) uses a small plastic transparent cap attached to the tip of the colonoscope that can depress and flatten colonic folds and thus improve visualisation of their proximal aspects. The aim of this study was to compare CAC with standard colonoscopy (SC; high-definition white light) for adenoma detection rates. DESIGN:This is a prospective randomised controlled trial. SETTING:The study was performed in a tertiary-care Veterans Affairs Medical Center in the USA. PATIENTS:Subjects undergoing screening or surveillance colonoscopy were enrolled. INTERVENTIONS:Subjects were randomised to undergo either CAC or SC. MAIN OUTCOME MEASURES:The outcome measures were the proportion of subjects with at least one adenoma, the number of adenomas detected per subject, insertion time, caecal intubation rates and complications. RESULTS:420 subjects were enrolled and included in the study (210 in each group). The proportion of subjects with at least one adenoma was higher with CAC compared to SC (69% vs 56%, p=0.009). CAC also detected a higher number of adenomas per subject (2.3 vs 1.4, p<0.001). The caecal intubation time was shorter with CAC (3.29 min vs 3.98 min, p<0.001). The caecal intubation rates were similar in the two groups (99% vs 98%, p=0.37). There were no complications associated with CAC or SC. CONCLUSIONS:CAC detected a 13% higher number of subjects with at least one adenoma and 59% higher adenomas per subject. CAC is a safe, effective and practical means to improve adenoma detection rates. CLINICAL TRIAL REGISTRATION:NCT 01211132.
10.1136/gutjnl-2011-300187
Efficacy of cap-assisted colonoscopy according to lesion location and endoscopist training level.
Kim Dong Jun,Kim Hyung Wook,Park Su Bum,Kang Dae Hwan,Choi Cheol Woong,Hong Joung Boom,Ji Byoung Hoon,Lee Chang Seok
World journal of gastroenterology
AIM:To evaluate the efficacy of cap-assisted colonoscopy (CAC) for detection of colorectal polyps and adenomas according to the lesion location and endoscopist training level. METHODS:Patients 20 years or older, who underwent their first screening colonoscopy in a single tertiary center from May 2011 to December 2012 were enrolled in this study. All patients underwent either CAC or standard colonoscopy (SC), and all of the procedures were performed by 11 endoscopists (8 trainees and 3 experts). All procedures were performed with high-definition colonoscopes and narrow band imaging. The eight trainees had experiences of performing 150 to 500 colonoscopies, and the three experts had experiences of performing more than 3000 colonoscopies. A 4-mm-long transparent cap was attached to the end of a colonoscope in the CAC group. We retrospectively evaluated the number of polyps and adenomas, polyp detection rate (PDR), and the number of adenomas and adenoma detection rate (ADR) according to the lesion location and endoscopist training level between CAC and SC. We also evaluated the number of polyps and adenomas according to their size between CAC and SC. RESULTS:Overall, PDR and ADR using CAC were significantly higher than those using SC for both whole colon (48.5% vs 40.7%, P = 0.012; 35.7% vs 28.3%, P = 0.012) and right-side colon (35.3% vs 26.6%, P = 0.002; 27.0% vs 16.9%, P < 0.001). The number of polyps and adenomas per patient using CAC was significantly higher than that using SC for both the whole colon (1.07 ± 1.59 vs 0.82 ± 1.31, P = 0.008; 0.72 ± 1.32 vs 0.50 ± 1.01, P = 0.003) and right-side colon (0.66 ± 1.18 vs 0.41 ± 0.83, P < 0.001; 0.46 ± 0.97 vs 0.25 ± 0.67, P < 0.001). In the trainee group, the PDR and ADR using CAC were significantly higher than those using SC for both the whole colon (46.7% vs 39.7%, P = 0.040; 33.9% vs 26.0%, P =0.012) and right-side colon (34.2% vs 26.5%, P = 0.015; 25.3% vs 15.9%, P = 0.001). In the expert group, the PDR and ADR using CAC were significantly higher than those using SC only for the right-side colon (42.1% vs 27.0%, P =0.035; 36.8% vs 21.0%, P = 0.020). CONCLUSION:CAC is more effective than SC for detection of colorectal polyps and adenomas, especially when performed by trainees and when the lesions are located in the right-side colon.
10.3748/wjg.v21.i20.6261
Benefits and limitations of cap-fitted colonoscopy in screening colonoscopy.
Horiuchi Akira,Nakayama Yoshiko,Kajiyama Masashi,Kato Naoyuki,Ichise Yasuyuki,Tanaka Naoki
Digestive diseases and sciences
BACKGROUND:Colonoscopy is widely used to detect colorectal cancer and to remove precancerous lesions to reduce the risk of colonic cancer. AIMS:To examine the benefits and limitations of cap-fitted colonoscopy compared to conventional colonoscopy in terms of technical performance and colorectal adenoma detection rate. METHODS:Screening colonoscopies performed from 2009 to 2010 with or without a transparent cap were retrospectively examined to compare the rate of successful intubation, cecal intubation time, and number, size, shape, and location of adenomas detected. An inclusion criterion was visualization of >95 % of the right colon. RESULTS:Data from 2,301 colonoscopies (1,165 with cap-fitted colonoscopy, 1,136 without the transparent cap) were retrospectively analyzed. Procedures were performed by four experienced endoscopists. The subjects' demographic characteristics and technical performances were similar between the two methods. The only significant difference in the technical performance between the two techniques was a shorter cecal intubation time with cap-fitted colonoscopy (5.3 vs. 6.6 min; p = 0.045) by one endoscopist. The total number of adenomas detected was significantly higher with cap-fitted colonoscopy than without the cap (586 vs. 484, respectively; p < 0.0001). Adenoma detection with cap-fitted endoscopy was significantly higher in the right colon than in the left colon (19 vs. 12 %, respectively; p = 0.0001). CONCLUSION:Cap-fitted colonoscopy did not improve the technical aspects of colonoscopy but significantly increased adenoma detection, especially in the right colon. It did not increase the detection rate of flat or depressed adenomas.
10.1007/s10620-012-2403-1
Cuff-assisted versus cap-assisted colonoscopy for adenoma detection: results of a randomized study.
Sola-Vera Javier,Catalá Lourdes,Uceda Francisco,Picó María Dolores,Pérez Rabasco Estefanía,Sáez Jesús,Jiménez Nuria,Arjona María Dolores,Fernández María,Girona Eva,García-Sepulcre Mariana Fe
Endoscopy
BACKGROUND:The adenoma detection rate (ADR) is the most important marker of colonoscopy quality. Devices to improve adenoma detection have been developed, such as the Endocuff and transparent cap. The aim of the current study was to examine whether there was a difference in ADR between Endocuff-assisted (EAC) and cap-assisted colonoscopy (CAC). METHODS:A randomized prospective trial was conducted. Eligible patients included adults ≥ 18 years referred because of symptoms, surveillance, or colonoscopies as part of the Bowel Cancer Screening Programme (BCSP). The primary outcome measure was ADR. Secondary outcomes included mean number of adenomas, mean number of polyps, polyp detection rate, cecal intubation rate, and time to cecal intubation. Procedural measures, device removal rate, and adverse events were also recorded. RESULTS:A total of 711 patients (51.1 % men; median age 63 years) were included, of whom 357 patients were randomized to EAC and 354 patients to CAC. In the intention-to-treat analysis, the ADR was similar in both groups: EAC 50.4 % (95 % confidence interval [CI] 45.1 - 55.7) vs. CAC 50.6 % (95 %CI 45.2 - 55.9). Similar results were obtained in the per-protocol analysis: EAC 51.6 % (95 %CI 46.2 - 57) vs. CAC 51.4 % (95 %CI 46 - 56.8). There were no differences between the two devices in ADR according to the mean number of adenomas and polyps per procedure, polyp detection rate, cecal intubation rate, and time to cecal intubation. Device removal rate and adverse events were also similar. CONCLUSION:In this randomized study, no differences in ADR were found between Endocuff- and cap-assisted colonoscopy.
10.1055/a-0901-7306
Cap-assisted colonoscopy versus standard colonoscopy: is the cap beneficial? A meta-analysis of randomized controlled trials.
Mir Fazia A,Boumitri Christine,Ashraf Imran,Matteson-Kome Michelle L,Nguyen Douglas L,Puli Srinivas R,Bechtold Matthew L
Annals of gastroenterology
BACKGROUND:In an effort to improve visualization during colonoscopy, a transparent plastic cap or hood may be placed on the end of the colonoscope. Cap-assisted colonoscopy (CAC) has been studied and is thought to improve polyp detection. Numerous studies have been conducted comparing pertinent clinical outcomes between CAC and standard colonoscopy (SC) with inconsistent results. METHODS:Numerous databases were searched in November 2016. Only randomized controlled trials (RCTs) involving adult subjects that compared CAC to SC were included. Outcomes of total colonoscopy time, time to cecum, cecal intubation rate, terminal ileum intubation rate, polyp detection rate (PDR), and adenoma detection rate (ADR) were analyzed in terms of odds ratio (OR) or mean difference (MD) with fixed effect and random effects models. RESULTS:Five hundred eighty-nine articles and abstracts were discovered. Of these, 23 RCTs (n=12,947) were included in the analysis. CAC showed statistically significant superiority in total colonoscopy time (MD -1.51 min; 95% confidence interval [CI] -2.67 to -0.34; P<0.01) and time to cecum (MD -0.82 min; 95%CI -1.20 to -0.44; P<0.01) compared to SC. CAC also showed better PDR (OR 1.17; 95%CI 1.06-1.29; P<0.01) but not ADR (OR 1.11; 95%CI 0.95-1.30; P=0.20). In contrast, on sensitivity analysis, ADR was better with CAC. Terminal ileum intubation and cecal intubation rates demonstrated no significant difference between the two groups (P=0.11 and P=0.73, respectively). CONCLUSIONS:The use of a transparent cap during colonoscopy improves PDR while reducing procedure times. ADR may improve in cap-assisted colonoscopy but further studies are required to confirm this.
10.20524/aog.2017.0180
Cap-assisted colonoscopy can increase the rate of sessile serrated lesion detection at the left lateral decubitus position: A retrospective case-control study.
Medicine
We investigated the effectiveness of cap-assisted colonoscopy conducted with the patient in the left lateral decubitus position at both the colonoscope's insertion and withdrawal timepoints compared to the effectiveness of colonoscopy without a cap conducted in the supine position at withdrawal. This was a case-control study, based on historical comparisons of patients over 2 time periods. The first group of patients underwent colonoscopies with a transparent cap and the patient was in the left lateral decubitus position at both the insertion and withdrawal timepoints from April to June 2019. The subsequent group underwent colonoscopies without a cap and with the patient in the supine position at withdrawal from July to September 2019. The rates of successful intubation, cecal intubation time, and number, size, shape, and location of the detected adenomas and sessile serrated lesions were compared between the 2 groups. Data from 644 colonoscopies (cap-assisted colonoscopy + left lateral decubitus position, n=320; other colonoscopies, n=324) were analyzed. The demographic characteristics and technical performances were similar. The SSL detection rate was significantly higher with cap-assisted colonoscopy and the left lateral decubitus position than with other colonoscopies (3.4% vs 0.93%, P=.029). The adenoma detection rates in the 2 groups were similar (31% and 28%, respectively, P=.43).Cap-assisted colonoscopy in the left lateral decubitus position may increase the detection rate of sessile serrated lesions compared to colonoscopy without a cap and supine position at withdrawal.
10.1097/MD.0000000000035264
Cap-assisted colonoscopy (CAC) significantly extends visualization in the right colon.
Frieling T,Neuhaus F,Heise J,Kreysel C,Hülsdonk A,Blank M,Czypull M
Zeitschrift fur Gastroenterologie
BACKGROUND:Although colonoscopy is the standard procedure in the diagnosis of colorectal neoplasia, a significant number of clinically relevant lesions may be missed even by experienced endoscopists using current technology. Particular problems may occur with blind spots behind the semilunar folds and within the right colon. A transparent cap mounted at the tip of a colonoscope may be an easy way to extend the visual field during colonoscopy and may improve the detection rate of mucosal lesions. However, data in the literature are controversial and the quantity of the potential extension of visualization by a transparent cap has not been reported yet. MATERIAL AND METHODS:The significance of cap-assisted colonoscopy (CAC) to increase visualization within different colonic segments (rectum, sigmoid colon, descending colon, transverse colon, ascending colon, cecum) was quantitatively analyzed by randomized back-to-back colonoscopies with and without cap. The investigations were performed in a colonic training model by 5 investigators. The inner colonic surface was stained by a raster of dots and the number of dots counted during colonoscopy served as a measure for the visible surface area of each segment. RESULTS:The time to advance the colonoscope to the respective colonic segments and the overall time to reach the cecum were not significantly different between conventional and CAC. In contrast, overall withdrawal time and withdrawal times for the cecum, ascending colon, descending colon and rectum were significantly longer for CAC, but not for the transverse and sigmoid colon. Visualization of the colonic surface was significantly increased during CAC. Overall, 59.76 ± 2.70 % of the maximal countable dots were visualized without cap and 85.36 ± 9.62 % with cap. The improvement of visualization was only significant for the right colon, but not for the rectum, sigmoid or descending colon. CONCLUSION:The finding of the present study suggests that the extension of visualization by CAC may be of particular value for the right colon.
10.1055/s-0031-1281707
Intestinal stent implantation using a water injection device with carbon dioxide and transparent cap: A case report.
Medicine
RATIONALE:Preoperative endoscopic intestinal stent placement can relieve the symptoms of malignant bowel obstruction (MBO) pending investigations, staging, and surgery, but it is a technically challenging procedure. This paper presents a woman with MBO who successfully underwent intestinal stent implantation using a water injection device with carbon dioxide and a transparent cap. PATIENT CONCERNS:We reported a technique for endoscopic intestinal stent placement. A 60-year-old female patient was admitted for abdominal pain and poor bowel movement for 10 days. Computed tomography at a local hospital suggested local stenosis. DIAGNOSES:A transparent cap was placed in front of a gastroscope and was used to cross part of the stenotic segment, with water being injected to fill the intestinal cavity continuously. An angiographic catheter was sent along the yellow zebra guidewire passing through the stenotic segment. After exchanging for a colonoscope, a 12-cm intestinal stent was placed along the guidewire. INTERVENTIONS:The physician used a single-person water injection-assisted colonoscopy technique in combination with a carbon dioxide gas pump to assist with the air insufflation for colonoscope insertion through the lumen and repeatedly injected water solution to ensure a transparent colonoscopic view. OUTCOMES:No intraoperative or postoperative complications were observed. One week after endoscopic intestinal stent placement, the patient underwent radical left hemicolectomy for colon cancer and release of bowel adhesion. The postoperative pathology revealed adenocarcinoma with perineural invasion. The patient recovered well after surgery. LESSONS:Single-person intestinal stent implantation using a water injection device with carbon dioxide and a transparent cap can achieve endoscopic intestinal stent placement for MBO.
10.1097/MD.0000000000036330
The Use of Attachment Devices to Aid in Adenoma Detection.
Current treatment options in gastroenterology
PURPOSE OF REVIEW:With the intent of maximizing adenoma detection rate (ADR), different devices and colonoscopic innovations have been introduced over the past few years. There are a variety of attachment devices available for use in colonoscopy, all intended to improve ADR. In this review, we evaluate the evidence surrounding the available attachment devices and their impact on ADR. RECENT FINDINGS:Endocuff, Endoring, Transparent cap, G-EYE balloon, and Third Eye Retroscope were all included in this review. Three of the devices, Endocuff, Endoring, and transparent hood or cap, have been shown to increase ADR without significantly altering the use of the colonoscope. Although balloon-assisted colonoscopy is not currently FDA-approved, it has the potential to increase ADR as well. SUMMARY:Mechanical enhancement has been shown to complement the current forward-viewing colonoscope, and Endocuff appears to be the most beneficial attachment to improve ADR.
10.1007/s11938-020-00280-4
To cap/cuff or ring: do distal attachment devices improve the adenoma detection?
Thayalasekaran Sreedhari,Alkandari Asma,Varytimiadis Lazaros,Subramaniam Sharmila,Coda Sergio,Longcroft-Wheaton Gaius,Bhandari Pradeep
Expert review of gastroenterology & hepatology
INTRODUCTION:Colonoscopy reduces the risk of colorectal cancer, by interrupting the adenoma-carcinoma sequence enabling the detection and removal of adenomas before they turn into colorectal cancer. Colonoscopy has its limitations as adenoma miss rates as high as 25% have been reported. The reasons for missed pathology are complicated and multi-factorial. The recent drive to improve adenoma detection rates has led to a plethora of new technologies. Areas covered: An increasing number of advanced endoscopes and distal attachment devices have appeared in the market. Advanced endoscopes aim to improve mucosal visualization by widening the field of view. Distal attachment devices aim to increase adenoma detection behind folds by flattening folds on withdrawal. In this review article, we discuss the three following distal attachment devices: the transparent cap, the Endocuff, and the Endoring. Expert commentary: The authors believe that the distal attachment devices will have a greater benefit for endoscopists with low baseline adenoma detection rates.
10.1080/17474124.2019.1551131
Efficacy of total colonoscopy with a transparent cap in comparison with colonoscopy without the cap.
Matsushita M,Hajiro K,Okazaki K,Takakuwa H,Tominaga M
Endoscopy
BACKGROUND AND STUDY AIMS:In spite of scrupulous inspection during routine colonoscopy, small lesions behind the semilunar folds can be situated in blind spots, where they are easily overlooked. The aim of this study was to evaluate the efficacy of total colonoscopy with a transparent cap in identifying such lesions, in comparison with colonoscopy without the cap. PATIENTS AND METHODS:In 24 patients with colorectal polyps, tandem colonoscopic procedures were carried out on the same day in random order, first without a transparent cap and then with the cap (without-to-with), or first with the cap and then without the cap (with-to-without). The time required for intubation as far as the cecum, the number of polyps detected, and procedure-related complications were recorded. The frequencies of terminal ileal intubation and retroflexion within the rectum were also recorded. RESULTS:Total colonoscopy was carried out in all of the patients without any complications. Colonoscopy with a transparent cap ensured good visual fields during insertion and withdrawal of the colonoscope. There were no significant differences in the intubation time to the cecum or in the frequency of terminal ileal intubation between the two procedures. The miss rate for polyps was 15% in without-to-with tandem colonoscopies, and zero in with-to-without procedures (P = 0.0125). The diameter of all the missed polyps except for one lesion (8 mm) was less than 5 mm. Retroflexion within the rectum was more difficult using the colonoscope with the cap (P < 0.0001), and was successful in only one case using the cap. CONCLUSIONS:Total colonoscopy with a transparent cap allows inspection of the blind area of the colonic mucosa behind the semilunar folds, with good visual fields. This method is potentially useful for both screening and diagnostic purposes.
10.1055/s-2007-1001305
Transparent cap-assisted colonoscopy versus standard adult colonoscopy: a systematic review and meta-analysis.
Westwood David A,Alexakis Nicholas,Connor Saxon J
Diseases of the colon and rectum
BACKGROUND:Cap-assisted colonoscopy uses a transparent plastic hood attached to the tip of the colonoscope to flatten the semilunar folds and improve mucosal exposure. Several studies have examined the effect of cap-assisted colonoscopy on polyp detection, but the data are inconsistent. OBJECTIVE:This study aimed to evaluate whether cap-assisted colonoscopy improves the yield of colorectal neoplasia detected compared with standard colonoscopy. DATA SOURCES:A systematic search of the PubMed, MEDLINE, Embase, and Cochrane databases identified 12 studies that met the inclusion criteria for data extraction. STUDY SELECTION:Publications that compared cap-assisted colonoscopy vs standard colonoscopy in adults in a prospective randomized controlled study were selected for review. MAIN OUTCOME MEASURES:The primary outcomes used for meta-analysis were cecal intubation rate, cecal intubation time, and polyp detection rate. The analysis was performed using a fixed-effect model. Outcomes were calculated as odds ratios or standardized mean differences with 95% confidence intervals. The average polyp miss rate determined by tandem colonoscopy was also calculated. RESULTS:The outcomes of 6185 patients were studied. Cap-assisted colonoscopy detected significantly more patients with polyps (OR 1.13; p = 0.030) and had a lower average polyp miss rate (12.2% vs 28.6%) than standard colonoscopy. Cap-assisted colonoscopy had a significantly higher cecal intubation rate than standard colonoscopy (OR 1.36; p = 0.020), whereas the time to cecal intubation (standard mean difference, 0.04 min; p = 0.280) was similar for the 2 colonoscope types. CONCLUSIONS:Cap-assisted colonoscopy is associated with improved detection of colorectal neoplasia and higher cecal intubation rates than standard adult colonoscopy.
10.1097/DCR.0b013e31823461ef
Feasibility of the transparent cap-fitted colonoscope for screening and mucosal resection.
Tada M,Inoue H,Yabata E,Okabe S,Endo M
Diseases of the colon and rectum
PURPOSE:A transparent plastic cap of 17 mm in outer diameter, 15 mm in inner diameter, and 10 mm in length can be easily attached to the tip of a colonoscope. By using the cap, a better view of the lesions hiding at the opposite side of the fold can be obtained. When a flat colonic lesion is found, a submucosal injection of saline solution is performed, the target mucosa is sucked inside the cap, snared under a full endoscopic suction, and resected by an electrical current. This procedure is called endoscopic mucosal resection using transparent cap-fitted endoscope (EMRC). Feasibility of the cap-fitted colonoscope for screening colonoscopic examination and mucosal resection was evaluated. MATERIALS AND METHODS:One hundred forty patients were randomly allocated for screening with a normal colonoscope (NCF) or that with the cap-fitted colonoscope (CCF). Average time for insertion up to the cecum, patients' discomfort during insertion expressed in 4 degrees, and average number of lesions found in one patient were compared. Thirty lesions randomly allocated for mucosal resection with conventional strip biopsy or EMRC were also evaluated. RESULTS:Time consumed for insertion up to the cecum with the CCF (12.4 +/- 6.6 minutes) was the same as that with the NCF (12.3 +/- 5.2 minutes), and there was no significant difference in patients' discomfort; however, the average number of lesions found in one patient was larger when using the CCF (0.86 +/- 0.96) than when using the NCF (0.58 +/- 0.81). For mucosal resection, 40 flat or wide-based lesions including 6 mucosal carcinomas were resected with EMRC. We experienced only one pinhole perforation of the ascending colon by heat damage, which was treated successfully by surgery. There was no other major complication or recurrence. CONCLUSION:The cap-fitted endoscope was equal in maneuverability, was excellent in sensitivity in comparison with the regular colonoscope, and was thought to be feasible both in screening and mucosal resection.
10.1007/bf02055390
The use of a transparent cap in sigmoidoscopy-A randomized controlled clinical trial on pain, time and success rate.
Ploug Magnus,Poulsen Jacob Kvist,Jensen Henning Quist,Achiam Michael
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Trials on cap-assisted colonoscopy have shown a reduction in pain, faster intubation time and a higher success rate attributed to the use of the cap. No similar studies have been published on sigmoidoscopy even though it is a common procedure associated with significant pain. Our objective was to investigate whether the use of a transparent cap for sigmoidoscopy has an impact on pain, time or success rate. To mimic the tendencies of daily clinical practice, the trainee endoscopist performed the procedures, and no analgesics or sedatives were used. We conducted a randomized, controlled clinical trial with a parallel design consisting of two groups masked for the intervention. The primary endpoint was pain, recorded on a 100-mm visual analogue scale (VAS). Our results found cap-assisted sigmoidoscopy to be significantly more painful than non-cap-assisted sigmoidoscopy (median VAS 50 vs. 38 mm; p = 0.047). We found no differences on time or success rate due to the cap. Our results suggest pain management, e.g. analgesics which is not routinely used for sigmoidoscopy, when a cap is used to gain therapeutic or diagnostic advantages. ClinicalTrials.gov Identifier: NCT02243930.
10.1007/s12664-017-0776-y
Colonoscopy attachments for the detection of precancerous lesions during colonoscopy: A review of the literature.
Gkolfakis Paraskevas,Tziatzios Georgios,Spartalis Eleftherios,Papanikolaou Ioannis S,Triantafyllou Konstantinos
World journal of gastroenterology
Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting up to almost one fourth of existing adenomas. Among reasons accounting for such failures, is the inability to meticulously visualize the colonic mucosa located either proximal to haustral folds or anatomic curves, including the hepatic and splenic flexures. In order to overcome these limitations, various colonoscope attachments aiming to improve mucosal visualization have been developed. All of them - transparent cap, Endocuff, Endocuff Vision and Endorings - are simply mounted onto the distal tip of the scope. In this review article, we introduce the rationale of their development, present their mode of action and discuss in detail the effect of their implementation in the detection of lesions during colonoscopy.
10.3748/wjg.v24.i37.4243
Technical considerations and patient comfort in total colonoscopy with and without a transparent cap: initial experiences from a pilot study.
Dafnis G M
Endoscopy
BACKGROUND AND STUDY AIMS:Even though colonoscopy was introduced 30 years ago, endoscopists still leave a small percentage of the colonic mucosal surface unexamined because of the limitations of the procedure, so there is still room for technical improvements. The aim of this pilot study was to test the feasibility of attaching a transparent cap to the tip of the colonoscope, partly to gather basic data and experience for planning a larger randomized study, and partly to evaluate any technical advantages or disadvantages, and also to appraise the patients' experiences. PATIENTS AND METHODS:In 50 consecutive patients examined by a single experienced endoscopist, a prospective pilot study was carried out comparing the use of a colonoscope fitted with a transparent cap (in half of the colonoscopies) with the use of an ordinary colonoscope without a cap (in the remaining 25 patients). The following parameters were recorded: indication for colonoscopy, time to reach the cecum, total time for the colonoscopy, findings, diagnosis, type of colonoscopy (diagnostic or therapeutic, partial or total, ileal intubation), the amount of analgesia and sedation given during the endoscopy, and complications. At the end of the examination and also before leaving the hospital, the patients were asked by a nurse to estimate pain experienced during the colonoscopy, using a visual analogue scale. RESULTS:The time for the procedure, the ability to perform a complete colonoscopy (including ileal intubation when it was medically relevant), and the complication rate turned out to be similar in both groups. There were no differences between the amounts of analgesia and sedation given during the endoscopy or between the patients' estimations of the pain experienced. CONCLUSIONS:The time to reach the cecum and the total time for the colonoscopy is the same with or without the cap, which is well tolerated by patients. Using the cap greatly facilitates the possibility of finding small polyps behind folds in the colon, because the folds can be straightened, thereby improving the view, although in this small pilot study it could not be proven that the number of polyps found was greater using a cap-fitted colonoscope.
10.1055/s-2000-637
Cap-assisted gastroscope versus cap-assisted colonoscope for examination of difficult sigmoid colons in a nonsedated Asian population: a randomized study.
Kim Dae-Hyun,Park Seon-Young,Park Chang-Hwan,Ki Ho-Seok,Jun Chung-Hwan,Kim Hyun-Soo,Choi Sung-Kyu,Rew Jong-Sun
Gastrointestinal endoscopy
BACKGROUND:Studies 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. OBJECTIVE:To 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. DESIGN:Randomized, controlled study. SETTING:Tertiary-care referral center. PATIENTS:One hundred thirty-nine patients with technically difficult sigmoid colons were studied. INTERVENTION:Colonoscopy with either an E-cap (n = 69) or a C-cap (n = 70). MAIN OUTCOME MEASUREMENTS:Cecal intubation rate, cecal intubation time, patient-assessed pain score, and endoscopist-assessed pain score. RESULTS:The 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/m(2)), 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). LIMITATIONS:Single-center experience, lack of a gastroscope control group without a cap. CONCLUSION:The 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.).
10.1016/j.gie.2013.09.021
Transparent cap improves patients' tolerance of colonoscopy and shortens examination time by inexperienced endoscopists.
Dai Jun,Feng Nan,Lu Hong,Li Xiao Bo,Yang Chuan Hua,Ge Zhi Zheng
Journal of digestive diseases
OBJECTIVE:Up to 10% of colonoscopy procedures cannot be completed and polyps may be missed because of patients' discomfort and the endoscopists' technique. The aim of this study was to test the feasibility and safety of attaching a transparent cap to improve the outcome, especially for inexperienced endoscopists. METHODS:A total of 250 patients were randomized to undergoing either a cap-fitted colonoscopy (CCF) or a normal colonoscopy without a cap (NCCF). The procedures were performed by an experienced or inexperienced endoscopist, and the time to reach the cecum, the total colonoscopy time and the polyp detection rate were recorded. Visual analogue scales (VAS) assessing the severity of abdominal pain and distension were obtained. RESULTS:For the experienced endoscopist there was no difference between CCF and NCCF on the time to reach the cecum and the time for the whole procedure. But for the inexperienced endoscopist, both times were significantly shorter in the CCF group than in the NCCF group (9.48 min vs. 12.45 min; 18.50 min vs. 21.89 min, respectively, P < 0.05). No complication was observed except some abdominal pain and distension. The VAS scores of abdominal pain and distension were significantly lower in CCF group than those in the NCCF group for the two endoscopists. There was no significant difference in the number of polyps found between the two groups. CONCLUSION:A cap-fitted colonoscopy can shorten the examination time for inexperienced endoscopists. It can also reduce the patients' discomfort during the procedure.
10.1111/j.1751-2980.2010.00460.x
Transparent Cap Colonoscopy versus Standard Colonoscopy for Investigation of Gastrointestinal Tract Conditions.
Morgan Jenna,Thomas Kathryn,Lee-Robichaud Heather,Nelson Richard L
The Cochrane database of systematic reviews
BACKGROUND:Colonoscopy is considered the gold-standard investigation for screening and diagnosis of colorectal cancer. It is also becoming increasingly desirable for assessment, management, diagnosis and follow-up of other colorectal diseases, such as inflammatory bowel diseases and acute diverticulitis. Hence, due to the increasing demand for colonoscopy, devices to advance examination techniques are highly sought-after and the colonoscope with the transparent cap could be one of these. OBJECTIVES:To identify and review all relevant data in order to determine whether colonoscopy with a transparent cap is a more effective diagnostic tool than colonoscopy. SEARCH STRATEGY:We searched the MEDLINE, EMBASE and CINAHL databases, and the Cochrane Central Register of Controlled Trials for all randomised controlled trials (RCTs) comparing the use of colonoscopy with a transparent cap with standard colonoscopy. SELECTION CRITERIA:Studies were included if they were randomised controlled trials which compared the use of colonoscopy with a transparent cap with standard colonoscopy. DATA COLLECTION AND ANALYSIS:Data on study methods, participants, interventions used and outcomes measured was extracted from each study. Data was entered into the Cochrane Review Manager software (RevMan 5.0, 2008) and analysed using Cochrane MetaView. MAIN RESULTS:In the present meta-analysis, we considered for the first time all five randomised controlled trials so far performed. The findings of our work indicate that colonoscopy with transparent cap has a faster caecal intubation time when compared with standard colonoscopy. Reviewing studies individually would also seem to favour colonoscopy with transparent cap for polyp detection rate and pain during procedure but due to lack of comparable data meta-analysis was not feasible. AUTHORS' CONCLUSIONS:This review suggests that a transparent cap on the end of the colonoscope may give a marginally faster caecal intubation time compared with standard colonoscopy. It also suggests that there is a better polyp detection rate and less pain with the cap. However, the authors feel that further randomised controlled trials in this area would provide more clinically significant information on this adjunct to colonoscopy.
10.1002/14651858.CD008211.pub2
Transparent cap colonoscopy versus standard colonoscopy: a systematic review and meta-analysis.
Morgan Jenna L,Thomas Kathryn,Braungart Sarah,Nelson Richard L
Techniques in coloproctology
Due to the increasing demand for colonoscopy, devices to advance examination techniques are highly sought after. Several studies have examined the use of a transparent cap attached to the tip of the colonoscope, but the data are inconsistent. The aim of our study was to establish whether transparent cap colonoscopy is beneficial in the improvement of caecal intubation rate, time and polyp detection. We undertook a systematic review and meta-analysis in the form of a Cochrane review to evaluate these outcomes. We included fourteen randomised controlled trials that have been published to date. Transparent cap colonoscopy demonstrates a significant reduction in caecal intubation time, by an average of 48 s, when compared to standard colonoscopy. There was no significant difference in caecal intubation rate or polyp detection between the two groups. Despite a significant difference in caecal intubation time, the clinical significance of the transparent cap remains to be seen. We believe further research is needed to investigate this adjunct.
10.1007/s10151-013-0974-2
Transparent cap colonoscopy versus standard colonoscopy to improve caecal intubation.
The Cochrane database of systematic reviews
BACKGROUND:Colonoscopy is considered the gold-standard investigation for screening and diagnosis of colorectal cancer. It is also becoming increasingly desirable for assessment, management, diagnosis and follow-up of other colorectal diseases, such as inflammatory bowel diseases and acute diverticulitis. Hence, due to the increasing demand for colonoscopy, devices to advance examination techniques are highly sought-after and the colonoscope with the transparent cap could be one of these. OBJECTIVES:To identify and review all relevant data in order to determine whether colonoscopy with a transparent cap is a more effective diagnostic tool than colonoscopy. SEARCH METHODS:We searched the MEDLINE, EMBASE and CINAHL databases, and the Cochrane Central Register of Controlled Trials for all randomised controlled trials (RCTs) comparing the use of colonoscopy with a transparent cap with standard colonoscopy. SELECTION CRITERIA:Studies were included if they were randomised controlled trials which compared the use of colonoscopy with a transparent cap with standard colonoscopy. DATA COLLECTION AND ANALYSIS:Data on study methods, participants, interventions used and outcomes measured was extracted from each study. Data was entered into the Cochrane Review Manager software (RevMan 5.0, 2008) and analysed using Cochrane MetaView. MAIN RESULTS:In the present meta-analysis, we considered 14 randomised controlled trials so far published. The findings of our work indicate that colonoscopy with transparent cap has a faster caecal intubation time when compared with standard colonoscopy. Reviewing studies individually would also seem to favour colonoscopy with transparent cap for polyp detection rate and pain during procedure but due to lack of comparable data meta-analysis was not feasible. AUTHORS' CONCLUSIONS:This review suggests that a transparent cap on the end of the colonoscope may give a marginally faster caecal intubation time compared with standard colonoscopy. It also suggests that there is a better polyp detection rate and less pain with the cap. However, the authors feel that further randomised controlled trials in this area would provide more clinically significant information on this adjunct to colonoscopy.
10.1002/14651858.CD008211.pub3