Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial

Area of Science:

• Gastroenterology
• Endoscopy
• Cancer Prevention

Background:

• Colonoscopy is a key tool for colorectal cancer screening and surveillance.
• Improving adenoma detection rates is crucial for enhancing colonoscopy efficacy.
• Cap-assisted colonoscopy (CAC) utilizes a transparent cap to improve visualization of colonic folds.

Purpose of the Study:

• To compare the adenoma detection rates of cap-assisted colonoscopy (CAC) versus standard colonoscopy (SC).
• To evaluate the safety and practicality of CAC in a clinical setting.

Main Methods:

• Prospective randomized controlled trial involving 420 participants undergoing screening or surveillance colonoscopy.
• Participants were randomized to either CAC or SC (high-definition white light).
• Outcome measures included adenoma detection rates, number of adenomas per subject, insertion time, caecal intubation rates, and complications.

Main Results:

• Cap-assisted colonoscopy detected a significantly higher proportion of subjects with at least one adenoma (69% vs. 56%, p=0.009).
• CAC identified more adenomas per subject (2.3 vs. 1.4, p<0.001) and had a shorter insertion time (3.29 min vs. 3.98 min, p<0.001).
• Caecal intubation rates were comparable between groups (99% vs. 98%), with no reported complications for either method.

Conclusions:

• Cap-assisted colonoscopy is a safe, effective, and practical tool for improving adenoma detection during colonoscopy.
• CAC demonstrates a substantial increase in identifying subjects with adenomas and the number of adenomas detected per subject.
• The findings support the wider adoption of CAC to enhance colorectal cancer screening and surveillance outcomes.