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Cap-assisted colonoscopy more effective than standard method
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Cap-assisted colonoscopy can detect more polyps and requires a shorter cecal intubation time than standard colonoscopy, according to recent results.
In a meta-analysis of 16 randomized controlled trials published between 1997 and 2011, researchers evaluated data from 8,991 patients, including 4,501 who received cap-assisted colonoscopy (CAC) and 4,490 receiving standard colonoscopy (SC). Of the incorporated studies, 12 compared the efficacy of CAC and SC in detecting polyps; six compared efficacy according to detected adenomas; 10 compared cecal intubation rates; 10 reviewed intubation times, and five compared the total length of colonoscopy procedure.
The polyp detection rate was higher for CAC than SC (52.5% of patients vs. 47.5%, RR=1.08; 95% CI, 1.00-1.17), while adenoma detection rates were similar between the two methods (46.8% vs. 45.3%, RR=1.04; 95% CI, 0.90-1.19). Statistically significant heterogeneity was observed in both groups of studies.
The mean time for cecal intubation was slightly shorter for CAC compared with SC (–0.64 minutes, 95% CI, –1.19 to –0.10). The total time for colonoscopy was comparable between the two, with a mean difference of –0.97 minutes (95% CI, –2.33 to 0.40) favoring CAC. The rate of cecal intubation also was comparable (96.4% for CAC vs. 95.6% for SC, RR=1.00; 95% CI, 0.90-1.02). Statistically significant heterogeneity was observed in all three groups of studies.
Investigators also performed a subgroup analysis to determine the effect of cap length on colonoscopy results. Associations were found between a longer cap (7 mm or more) and reduced cecal intubation time (combined mean difference= –1.00, 95% CI; –1.41 to –0.60), and between a shorter cap (4 mm or less) and improved polyp detection (combined RR=1.10; 95% CI, 1.03-1.19).
“The difference in polyp detection is probably due to increase in detection of nonadenomatous polyps,” the researchers wrote. “Larger, well-designed studies focusing on adenomatous polyps are needed. The choice to use a cap would remain at the discretion of the endoscopist. It may be beneficial during screening colonoscopies, when training junior endoscopists, or as a rescue approach during failed colonoscopy.”
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