David G Hewett1, Douglas K Rex. 1. Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Abstract
BACKGROUND: Failures of adenoma detection diminish the effectiveness of colonoscopy. OBJECTIVE: This study investigated the impact of cap-fitted colonoscopy (CFC) on the adenoma miss rate at colonoscopy. DESIGN: Randomized, tandem colonoscopy study. SETTING:University hospital. PATIENTS: This study involved patients undergoing elective screening or surveillance colonoscopy. INTERVENTION: Patients were randomized to undergo cap-fitted (n = 52) or regular, high-definition (n = 48) colonoscopy before undergoing a second colonoscopy by the alternate method. During CFC, a plastic cap or hood was attached to the tip of the colonoscope, which was used to flatten haustral folds and improve mucosal exposure. MAIN OUTCOME MEASUREMENTS: The primary outcome measure was the miss rate for adenomas between patients who underwent CFC first and patients who underwent regular colonoscopy first. RESULTS: A total of 238 adenomas were detected in 67 patients (67%), with a combined overall miss rate of 27.7%, comprising 66 missed adenomas in 38 patients. Patients undergoing initial CFC had a significantly lower miss rate for all adenomas compared with that of patients undergoing regular colonoscopy (21% vs 33%, P = .039). Miss rates with CFC were significantly lower for adenomas of ≤5 mm (22% vs 35%; P = .037). There was no significant difference in per-patient miss rates between the initial CFC group (51%, n = 18) and the initial regular colonoscopy group (63%, n = 20, P = .36). LIMITATIONS: Single-center study with two endoscopists. CONCLUSION:CFC reduces miss rates for all adenomas and specifically for small adenomas. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT00577083).
RCT Entities:
BACKGROUND: Failures of adenoma detection diminish the effectiveness of colonoscopy. OBJECTIVE: This study investigated the impact of cap-fitted colonoscopy (CFC) on the adenoma miss rate at colonoscopy. DESIGN: Randomized, tandem colonoscopy study. SETTING: University hospital. PATIENTS: This study involved patients undergoing elective screening or surveillance colonoscopy. INTERVENTION: Patients were randomized to undergo cap-fitted (n = 52) or regular, high-definition (n = 48) colonoscopy before undergoing a second colonoscopy by the alternate method. During CFC, a plastic cap or hood was attached to the tip of the colonoscope, which was used to flatten haustral folds and improve mucosal exposure. MAIN OUTCOME MEASUREMENTS: The primary outcome measure was the miss rate for adenomas between patients who underwent CFC first and patients who underwent regular colonoscopy first. RESULTS: A total of 238 adenomas were detected in 67 patients (67%), with a combined overall miss rate of 27.7%, comprising 66 missed adenomas in 38 patients. Patients undergoing initial CFC had a significantly lower miss rate for all adenomas compared with that of patients undergoing regular colonoscopy (21% vs 33%, P = .039). Miss rates with CFC were significantly lower for adenomas of ≤5 mm (22% vs 35%; P = .037). There was no significant difference in per-patient miss rates between the initial CFC group (51%, n = 18) and the initial regular colonoscopy group (63%, n = 20, P = .36). LIMITATIONS: Single-center study with two endoscopists. CONCLUSION: CFC reduces miss rates for all adenomas and specifically for small adenomas. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT00577083).
Authors: David A Brown; Kenneth W Hance; Connie J Rogers; Leah B Sansbury; Paul S Albert; Gwen Murphy; Adeyinka O Laiyemo; Zhuoqiao Wang; Amanda J Cross; Arthur Schatzkin; Mark Danta; Preeyaporn Srasuebkul; Janaki Amin; Matthew Law; Samuel N Breit; Elaine Lanza Journal: Cancer Epidemiol Biomarkers Prev Date: 2011-12-05 Impact factor: 4.254
Authors: Peter D Siersema; Amit Rastogi; Anke M Leufkens; Paul A Akerman; Kassem Azzouzi; Richard I Rothstein; Frank P Vleggaar; Alessandro Repici; Giacomo Rando; Patrick I Okolo; Olivier Dewit; Ana Ignjatovic; Elizabeth Odstrcil; James East; Pierre H Deprez; Brian P Saunders; Anthony N Kalloo; Bradley Creel; Vikas Singh; Anne Marie Lennon; Daniel C DeMarco Journal: World J Gastroenterol Date: 2012-07-14 Impact factor: 5.742