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Nishimoto S, Kudo T, Horiuchi I, Yabe K, Kurasawa S, Horiuchi A. Cap-assisted colonoscopy can increase the rate of sessile serrated lesion detection at the left lateral decubitus position: A retrospective case-control study. Medicine (Baltimore) 2023; 102:e35264. [PMID: 37746993 PMCID: PMC10519449 DOI: 10.1097/md.0000000000035264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/01/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
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.
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Affiliation(s)
- Satomi Nishimoto
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ichitaro Horiuchi
- Department of Gastroenterology, Shinshu University Hospital, Matsumoto, Japan
| | - Kiyoaki Yabe
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
| | - Shingo Kurasawa
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
- Department of Pediatrics, Shinshu University Hospital, Matsumoto, Japan
| | - Akira Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
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Kobayashi M, Akiyama S, Narasaka T, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Tsuchiya K, Kaise M, Nagata N. Multicenter propensity score-matched analysis comparing short versus long cap-assisted colonoscopy for acute hematochezia. JGH Open 2023; 7:487-496. [PMID: 37496816 PMCID: PMC10366493 DOI: 10.1002/jgh3.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 07/28/2023]
Abstract
Background and Aim While short and long attachment caps are available for colonoscopy, it is unclear which type is more appropriate for stigmata of recent hemorrhage (SRH) identification in acute hematochezia. This study aimed to compare the performance of short versus long caps in acute hematochezia diagnoses and outcomes. Methods We selected 6460 patients who underwent colonoscopy with attachment caps from 10 342 acute hematochezia cases in the CODE BLUE-J study. We performed propensity score matching (PSM) to balance baseline characteristics between short and long cap users. Then, the proportion of definitive or presumptive bleeding etiologies found on the initial colonoscopy and SRH identification rates were compared. We also evaluated rates of blood transfusions, interventional radiology, or surgery, as well as the rate of rebleeding and mortality within 30 days after the initial colonoscopy. Results A total of 3098 patients with acute hematochezia (1549 short cap and 1549 long cap users) were selected for PSM. The rate of colonic diverticular bleeding (CDB) diagnosis was significantly higher in long cap users (P = 0.006). While the two groups had similar rates of the other bleeding etiologies, the frequency of unknown etiologies was significantly lower in long cap users (P < 0.001). The rate of SRH with active bleeding was significantly higher in long cap users (P < 0.001). Other clinical outcomes did not differ significantly. Conclusion Compared to that with short caps, long cap-assisted colonoscopy is superior for the diagnosis of acute hematochezia, especially CDB, and the identification of active bleeding.
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Affiliation(s)
- Mariko Kobayashi
- Division of Endoscopic CenterUniversity of Tsukuba HospitalTsukubaJapan
| | | | - Toshiaki Narasaka
- Division of Endoscopic CenterUniversity of Tsukuba HospitalTsukubaJapan
- Department of GastroenterologyUniversity of TsukubaTsukubaJapan
| | | | - Atsushi Yamauchi
- Department of Gastroenterology and HepatologyKitano Hospital, Tazuke Kofukai Medical Research InstituteOsakaJapan
| | - Atsuo Yamada
- Department of GastroenterologyGraduate School of Medicine, The University of TokyoTokyoJapan
| | - Jun Omori
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Takashi Ikeya
- Department of GastroenterologySt. Luke's International UniversityTokyoJapan
| | - Taiki Aoyama
- Department of GastroenterologyHiroshima City Asa Citizens HospitalHiroshimaJapan
| | - Naoyuki Tominaga
- Department of GastroenterologySaga‐Ken Medical Centre KoseikanSagaJapan
| | - Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal MedicineSt Marianna University School of MedicineKawasakiJapan
| | - Takaaki Kishino
- Department of Gastroenterology and Hepatology, Center for Digestive and Liver DiseasesNara City HospitalNaraJapan
| | - Naoki Ishii
- Department of GastroenterologyTokyo Shinagawa HospitalTokyoJapan
| | - Tsunaki Sawada
- Department of EndoscopyNagoya University HospitalNagoyaJapan
| | - Masaki Murata
- Department of GastroenterologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Akinari Takao
- Department of GastroenterologyTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | | | - Ken Kinjo
- Department of GastroenterologyFukuoka University Chikushi HospitalFukuokaJapan
| | - Shunji Fujimori
- Department of GastroenterologyChiba Hokusoh Hospital, Nippon Medical SchoolChibaJapan
| | - Takahiro Uotani
- Department of GastroenterologyJapanese Red Cross Shizuoka HospitalShizuokaJapan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory MedicineKawasaki Medical School General Medical CenterOkayamaJapan
| | - Hiroki Sato
- Division of GastroenterologyGraduate School of Medical and Dental Sciences, Niigata UniversityNiigataJapan
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of EndoscopyUniversity of Miyazaki HospitalMiyazakiJapan
| | | | - Tomohiro Funabiki
- Department of Emergency MedicineFujita Health University HospitalToyoakeJapan
- Emergency and Critical Care CenterSaiseikai Yokohama Tobu HospitalYokohamaJapan
| | - Yuzuru Kinjo
- Department of GastroenterologyNaha City HospitalNahaJapan
| | - Akira Mizuki
- Department of Internal MedicineTokyo Saiseikai Central HospitalTokyoJapan
| | - Shu Kiyotoki
- Department of GastroenterologyShuto General HospitalYanai‐shiJapan
| | - Tatsuya Mikami
- Division of EndoscopyHirosaki University HospitalHirosakiJapan
| | - Ryosuke Gushima
- Department of Gastroenterology and HepatologyGraduate School of Medical Sciences, Kumamoto UniversityKumamotoJapan
| | - Hiroyuki Fujii
- Department of Gastroenterology and HepatologyNational Hospital Organization Fukuokahigashi Medical CenterKogaJapan
| | - Yuta Fuyuno
- Department of Medicine and Clinical ScienceGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Naohiko Gunji
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal MedicineIwate Medical UniversityMoriokaJapan
| | - Kazuyuki Narimatsu
- Department of Internal MedicineNational Defense Medical CollegeTokorozawaJapan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory MedicineKawasaki Medical SchoolKurashikiJapan
| | - Koji Nagaike
- Department of Gastroenterology and HepatologySuita Municipal HospitalSuitaJapan
| | - Tetsu Kinjo
- Department of EndoscopyUniversity of the Ryukyus HospitalNishiharaJapan
| | - Yorinobu Sumida
- Department of GastroenterologyNational Hospital Organization Kyushu Medical CenterFukuokaJapan
| | - Sadahiro Funakoshi
- Department of Gastroenterological EndoscopyFukuoka University HospitalFukuokaJapan
| | - Kiyonori Kobayashi
- Department of GastroenterologyKitasato University, School of MedicineSagamiharaJapan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and NeurologyAkita University Graduate School of MedicineAkitaJapan
| | - Yuga Komaki
- Digestive and Lifestyle Diseases, and Hygiene and Health Promotion MedicineKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | | | - Mitsuru Kaise
- Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan
| | - Naoyoshi Nagata
- Department of Gastroenterological EndoscopyTokyo Medical UniversityTokyoJapan
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineTokyoJapan
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Nutalapati V, Kanakadandi V, Desai M, Olyaee M, Rastogi A. Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials. Endosc Int Open 2018; 6:E1214-E1223. [PMID: 30302379 PMCID: PMC6175690 DOI: 10.1055/a-0650-4258] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/09/2018] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Standard colonoscopy (SC) is the preferred modality for screening for colon cancer; however, it carries a significant polyp/adenoma miss rate. Cap-assisted colonoscopy (CC) has been shown to improve polyp/adenoma detection rate, decrease cecal intubation time and increase cecal intubation rate when compared to standard colonoscopy (SC). However, data on adenoma detection rate (ADR) are conflicting. The aim of this meta-analysis was to compare the performance of CC with SC for ADR among high-quality randomized controlled trials. Patients and methods We performed an extensive literature search using MEDLINE, EMBASE, Scopus, Cochrane and Web of Science databases and abstracts published at national meetings. Only comparative studies between CC and SC were included if they reported ADR, adenoma per person (APP), cecal intubation rate, and cecal intubation time. The exclusion criterion for comparing ADR was studies with Jadad score ≤ 2. The odds ratio (OR) was calculated using Mantel-Haenszel method. I 2 test was used to measure heterogeneity among studies. Results Analysis of high-quality studies (Jadad score ≥ 3, total of 7 studies) showed that use of cap improved the ADR with the results being statistically significant (OR 1.18, 95 % CI 1.03 - 1.33) and detection of 0.16 (0.02 - 0.30) additional APP. The cecal intubation rate in the CC group was 96.3 % compared to 94.5 % with SC (total of 17 studies). Use of cap improved cecal intubation (OR 1.61, 95 % CI 1.33 - 1.95) when compared to SC ( P value < 0.001). Use of cap decreased cecal intubation time by an average of 0.88 minutes (95 % CI 0.37 - 1.39) or 53 seconds. Conclusions Meta-analysis of high-quality studies showed that CC improved the ADR compared to SC.
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Affiliation(s)
- Venkat Nutalapati
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Vijay Kanakadandi
- Department of Gastroenterology, The University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Madhav Desai
- Department of Gastroenterology, The University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Mojtaba Olyaee
- Department of Gastroenterology, The University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Amit Rastogi
- Department of Gastroenterology, The University of Kansas Medical Center, Kansas City, Kansas, United States,Corresponding author Amit Rastogi, MD Department of Gastroenterology & HepatologyUniversity of Kansas Medical Center3901 Rainbow BlvdKansas City, KS 66160USA
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Abstract
So, is there enough evidence to incorporate CC in clinical practice? If we interpret the literature and the meta-analysis by Nutalapati et al., the answer for the clinically-focused endoscopist, with regard to adenoma detection rate (ADR), at present, may be "no". Significant differences do not necessarily imply clinical benefits and translation into clinical practice. The answer for the improvement of cecal intubation frequency and intubation time by the cap depends on the focus of training commitment, because these effects of the cap may be beneficial, especially for unexperienced endoscopists. It is obvious that further studies are needed. In this line, it is interesting to know, that in a recent meta-analysis of prospective studies, the length of the transparent cap had opposite effects on investigation time and polyp detection rate. Whereas, the anal to cecal time was significantly shortened by a cap length of > 7 mm and a polyp detection rate was significantly improved by a cap length of < 4 mm.
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Affiliation(s)
- Thomas Frieling
- Department of Gastroenterology, Hepatology, Infectiology, Neurogastroenterology, Hematology, Oncology, and Palliative Medicine, HELIOS-Clinic Krefeld, Krefeld, Germany
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Fischbach W, Elsome R, Amlani B. Characteristics of right-sided colonic neoplasia and colonoscopy barriers limiting their early detection and prognosis: a review of the literature. Expert Rev Gastroenterol Hepatol 2018; 12:585-596. [PMID: 29781328 DOI: 10.1080/17474124.2018.1478728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Colonoscopy provides less protection from colorectal cancer in the right colon than the left. Areas covered: This review examines patient outcomes and colonoscopy success rates to identify factors that limit the protective effect of colonoscopy in the right colon. The MEDLINE and Embase databases were searched for literature from 2000 onwards, on the long-term outcomes and differences in screening practice between the right and left colon. In total, 12 systematic reviews (including nine meta-analyses) and 44 primary data records were included. Differences in patient outcomes and colonoscopy practice were identified between the right and left colon, suggesting that several factors, many of which disproportionally affect the right colon, impact lesion detection rates. Shorter withdrawal times reduce detection rates, while longer times significantly increase detection; mostly of adenomas in the right colon. Colonoscope attachments often only show a significant improvement in detection rates in the right colon, suggesting detection is more challenging due to visibility of the right colonic mucosa. Higher bowel cleansing grades significantly improve detection rates in the right colon compared to the left. Expert commentary: These findings confirm the need for continued improvement of colonoscopy effectiveness, and obligatory quality assessment, overall and especially in the right colon.
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Affiliation(s)
- Wolfgang Fischbach
- a Medizinische Klinik II , Klinikum Aschaffenburg-Alzenau , Aschaffenburg , Germany
| | | | - Bharat Amlani
- c Medical Affairs , Norgine Limited , Harefield , UK
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Floer M, Biecker E, Fitzlaff R, Röming H, Ameis D, Heinecke A, Kunsch S, Ellenrieder V, Ströbel P, Schepke M, Meister T. Higher adenoma detection rates with endocuff-assisted colonoscopy - a randomized controlled multicenter trial. PLoS One 2014; 9:e114267. [PMID: 25470133 PMCID: PMC4255000 DOI: 10.1371/journal.pone.0114267] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/31/2014] [Indexed: 12/19/2022] Open
Abstract
Objectives The Endocuff is a device mounted on the tip of the colonoscope to help flatten the colonic folds during withdrawal. This study aimed to compare the adenoma detection rates between Endocuff-assisted (EC) colonoscopy and standard colonoscopy (SC). Methods This randomized prospective multicenter trial was conducted at four academic endoscopy units in Germany. Participants: 500 patients (235 males, median age 64[IQR 54–73]) for colon adenoma detection purposes were included in the study. All patients were either allocated to EC or SC. The primary outcome measure was the determination of the adenoma detection rates (ADR). Results The ADR significantly increased with the use of the Endocuff compared to standard colonoscopy (35.4%[95% confidence interval{CI} 29–41%] vs. 20.7%[95%CI 15–26%], p<0.0001). Significantly more sessile polyps were detected by EC. Overall procedure time and withdrawal time did not differ. Caecal and ileum intubation rates were similar. No major adverse events occurred in both groups. In multivariate analysis, age (odds ratio [OR] 1.03; 95%[CI] 1.01–1.05), male sex (OR 1.74; 95%CI 1.10–2.73), withdrawal time (OR 1.16; 95%CI 1.05–1.30), procedure time (OR 1.07; 95%CI 1.04–1.10), colon cleanliness (OR 0.60; 95%CI 0.39–0.94) and use of Endocuff (OR 2.09; 95%CI 1.34–3.27) were independent predictors of adenoma detection rates. Conclusions EC increases the adenoma detection rate by 14.7%(95%CI 6.9–22.5%). EC is safe, effective, easy to handle and might reduce colorectal interval carcinomas. Trial Registration ClinicalTrials.gov NCT02034929.
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Affiliation(s)
- Martin Floer
- Departments of Gastroenterology, HELIOS Albert-Schweitzer-Hospital Northeim, Northeim, Germany
| | - Erwin Biecker
- HELIOS Medical Center Siegburg, Siegburg, Germany
- Department of Gastroenterology, Zollernalb Medical Center, Bailingen, Germany
| | | | - Hermann Röming
- Departments of Gastroenterology, HELIOS Albert-Schweitzer-Hospital Northeim, Northeim, Germany
| | - Detlev Ameis
- HELIOS St. Marienberg Hospital Helmstedt, Helmstedt, Germany
| | - Achim Heinecke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Steffen Kunsch
- Department of Gastroenterology II, University Medical Center Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology II, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Tobias Meister
- Departments of Gastroenterology, HELIOS Albert-Schweitzer-Hospital Northeim, Northeim, Germany
- * E-mail:
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Chen BL, Xing XB, Wang JH, Feng T, Xiong LS, Wang JP, Cui Y. Improved biopsy accuracy in Barrett’s esophagus with a transparent cap. World J Gastroenterol 2014; 20:4718-4722. [PMID: 24782624 PMCID: PMC4000508 DOI: 10.3748/wjg.v20.i16.4718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/10/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of endoscopy with a transparent cap on biopsy positioning in Barrett’s esophagus (BE).
METHODS: One hundred and sixty-eight patients with suspected BE at endoscopy were enrolled in our study from November 2007 to December 2009 and divided into two groups: transparent cap group (n = 60) and control group (n = 108). Endoscopy with or without a transparent cap and subsequent biopsy of suspected lesions were performed by five experienced endoscopists in our hospital. In both groups, two biopsy specimens were taken from each patient, and the columnar epithelium or goblet cells in histological assessment were used as the diagnostic standard for BE.
RESULTS: In the transparent cap group, 41 cases were tongue type, while 17 and two cases were identified as island type and circumferential type, respectively. In the control group, 65 tongue-type cases were confirmed, with 38 island-type and five circumferential-type cases. Moreover, there was no significant difference with regard to the composition of endoscopic BE types in the two groups (P > 0.05). In the biopsy specimens, BE was detected in 50 cases in the transparent cap group (83.3%, 50/60), whereas the detection rate in the control group (69.4%, 75/108) was lower compared to that in the transparent cap group (P < 0.05). In addition, goblet cells were recognized in only eight cases (all with columnar epithelium) (8/60, 13.3%) in the transparent cap group, with 11 cases in the control group.
CONCLUSION: Transparent cap-fitted endoscopy can guide biopsy positioning in BE without other accompanying complications, thus increasing the detection rate of BE.
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Allescher HD, Egger K, Faiss S, Frieling T, Hartmann D. Colorectal Adenoma - Resection Techniques and Surveillance. VISZERALMEDIZIN 2014; 30:57-60. [PMID: 26468296 PMCID: PMC4583059 DOI: 10.1159/000360188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Horiuchi A, Nakayama Y, Kajiyama M, Kato N, Ichise Y, Tanaka N. Benefits and limitations of cap-fitted colonoscopy in screening colonoscopy. Dig Dis Sci 2013; 58:534-9. [PMID: 23053884 DOI: 10.1007/s10620-012-2403-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/31/2012] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Akira Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, 399-4117, Japan.
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