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

Background: Clinical 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.

Objective: To assess the efficacy of a cap attached to the tip of a colonoscope for detection and resection of polyps by experienced colonoscopists.

Design: Prospective, randomized, controlled trial.

Setting: A tertiary referral center.

Patients and intervention: A 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 measurements: Cecal intubation time, total procedure time, required time for colonoscopic EMR of each polyp, and missing polyp rate.

Results: The 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).

Limitation: Single-center experience.

Conclusions: CAC may reduce the time required for colonoscopic EMR of each polyp and may also improve the polyp detection rate.