Prospective and Randomized Study to Evaluate the Clinical Impact of Cap Assisted Colonoscopy (CAC)

Abstract

Background: Although colonoscopy is the standard procedure in the diagnosis of colorectal neoplasia, a significant number of clinical relevant lesions may be missed even by experienced endoscopists using current technology. A transparent cap mounted at the tip of a colonoscope may be an easy way to extend the visual field during colonoscopy and may improve the detection rate of mucosal lesions.

Material and Methods: The significance of cap assisted (CAC) vs. conventional colonoscopy (CC) on polyp detection rate was evaluated in a prospective randomized controlled trial in 504 patients.

Results: CC and CAC detected polyps in 39.3 % and 31.8, not significantly different. There was also no significant difference between CAC and CC according to age, sex, indication for colonoscopy, diverticulosis, sedation, bowel cleansing, withdrawal time, time/number of attempts to intubate the cecal walve, number, localization, size or histology of polyps,. However, the time to reach the cecal floor and the overall time of colonoscopy were significantly lower for CAC (1 minute).

Conclusion: CAC was without clinical impact on polyp detection rate or performance of colonoscopy.

Zusammenfassung

Hintergrund: Obwohl die Koloskopie das Standardverfahren für die Diagnostik kolorektaler Neoplasien ist, wird ein signifikanter Anteil klinisch relevanter Schleimhautveränderungen auch von erfahrenen Endoskopikern mit neuster Technologie übersehen. Eine transparente Endoskopiekappe, die auf die Spitze des Koloskops positioniert wird, könnte ein einfaches Verfahren sein, das Gesichtsfeld zu erweitern und die Detektionsrate von Mukosaveränderungen während der Koloskopie zu erhöhen.

Material und Methode: Die Bedeutung der Kappenkoloskopie (CAC) vs. konventioneller Koloskopie (CC) für die Polypendetektionsrate wurde in einer prospektiven und randomisierten Studie an 504 Patienten überprüft.

Ergebnisse: CC und CAC detektierten Polypen in 39,3 % und 31,8, nicht statistisch unterschiedlich. Es fanden sich ebenfalls keine signifikanten Unterschiede bez. Alter, Geschlecht, Indikation zur Koloskopie, Divertikulose, Sedierung, Darmvorbereitung, Rückzugszeit, Zeit/Anzahl der Versuche der Ileozökalklappen-Intubation, Anzahl, Lokalisation, Größe oder Histologie der Polypen. Die Vorschubzeit zum Zökum und die gesamte Untersuchungszeit waren signifikant kürzer für CAC (1 Minute).

Schlussfolgerung: CAC ist ohne klinisch relevanten Benefit bez. der Polypenfindungsrate oder der Koloskopie-Performance.

Schlüsselwörter

Kappenkoloskopie - Polypenfindungsrate - Intervalkarzinome

Key words

cap assisted colonoscopy - polyp detection rate - interval carcinoma

• References

• 1 Schmiegel WC, Pox A, Reinacher-Schick G et al. S3 Guidelines for Colorectal Carcinoma Results of an Evidence-Based Consensus Conference on February 6/7, 2004 and June 8/9, 2007 (for the Topics IV, VI and VII). Z Gastroenterol 2010; 48: 65-136
• 2 Zauber AG, Winawer SJ, O´Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 3 Bokemeyer B, Bock H, Hüppe D et al. Screening colonoscopy for colorectal cancer prevention: results from a German online registry on 269000 cases. Eur J Gastroenterol Hepatol 2009; 21: 650-655
• 4 Pox CP, Altenhofen L, Brenner H et al. Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 2012; 142: 1460-1467
• 5 Altenhofen L. German Cancer Surveillance Program. Zentralinstitut für die Kassenärztliche Versorgung (ZI). Dt Ärzteblatt 2012; 109: B452-B454
• 6 Haseman JH, Lemmel GT, Rahmani EY et al. Failure of colonoscopy to detect colorectal ancer: evaluation of 47 cases in 20 hospitals. Gastrointest Endosc 1997; 45: 451-455
• 7 van Rijn JC, Reitsma JB, Stoker J et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol 2006; 101: 343-350
• 8 Rockey DC, Niezwiecki D, Davis W et al. Analysis of air contrast barium enema, computed tomographic colonography and colonoscopy. Lancet 2005; 365: 305-311
• 9 v Schönfeld J, Hinzmann S. Missed colonic adenomas in routine primary care endoscopy: a prospective tandem colonoscopy study. Z Gastroenterol 2010; 48: 1207-1210
• 10 Hosokawa O, Shirasaki S, Kaizaki Y et al. Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer. Endoscopy 2003; 35: 506-510
• 11 Bressler B, Paszat LF, Vinden C et al. Colonoscopic miss rates for rightsided colon cancer: a population-based analysis. Gastroenterology 2004; 127: 452-456
• 12 Baxter NN, Goldwasser MA, Paszat LF et al. Association of colonoscopy and death from colorectal cancer: a population-based, case-control study. Ann Int Med 2009; 150: 1-8
• 13 Rex DK. Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc 2000; 51: 33-36
• 14 Hixson LS, Fennerty MB, Sampliner RE et al. Prospective study of the frequency and size distribution of polyps missed by colonoscopy. J Nat Cancer Inst 1990; 82: 1769-1772-10
• 15 Imperiale TF, Glowinski EA, Lin-Cooper C et al. Five-year risk of colorectal neoplasia after negative screening colonoscopy. N Engl J Med 2008; 359: 1218-1224
• 16 Rex DK, Cutler CS, Lemmel GT et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997; 112: 24-28
• 17 Bressler B, Paszat LF, Chen Z et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132: 96-102
• 18 Ee HC, Semmens JB, Hoffman NE. Complete colonoscopy rarely misses cancer. Gastrointest Endosc 2002; 55: 167-171
• 19 Leaper M, Johnston MJ, Barclay M et al. Reasons for failure to diagnose colorectal carcinoma at colonoscopy. Endoscopy 2004; 36: 499-503
• 20 Robertson DJ, Greenberg ER, Beach M et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 2005; 129: 34-41
• 21 Hosokawa O, Shirasaki S, Kaizaki Y et al. Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer. Endoscopy 2003; 35: 506-510
• 22 Pickhardt PJ, Nugent PA, Mysliwiec PA et al. Location of adenomas missed by optical colonoscopy. Ann Int Med 2004; 141: 352-359
• 23 Tada M, Nnoue H, Yabata E et al. Feasibility of the transparent cap-fitted colonoscope for screening and mucosal resection. Dis Colon Rectum 1997; 40: 618-621
• 24 Matsushita M, Hajiro K, Okazaki K et al. Efficacy of total colonoscopy with a transparent cap in comparison with colonoscopy without the cap. Endoscopy 1998; 30: 444-447
• 25 Dafnis G. Technical considerations and patient comfort in total colonoscopy with and without a transparent cap: initial experiences from a pilot study. Endoscopy 2000; 32: 381-384
• 26 Lee YT, Hul AJ, Wong VWS et al. Improved colonoscopy success rate with distally attached mucosectomy cap. Endoscopy 2006; 38: 739-742
• 27 Lee YT, Hin L, Hui AJ et al. Efficacy of cap-assisted colonoscopy in comparison with regular colonoscopy: a randomized controlled study. Am J Gastroenterol 2009; 104: 41-46
• 28 Hewett DG, Rex DK. Cap-fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss rates. Gastrointest Endosc 2010; 72: 775-781
• 29 Dai J, Feng N, Lu H et al. Transparent cap improves pantient´s tolerance of colonocscopy and shortens examination time by inexperienced endoscopists. J Dig Dis 2010; 11: 364-368
• 30 Tee H-P, Corte C, Al-Ghamdi H et al. Prospective randomized controlled trial evaluating cap-assisted colonoscopy vs standard colonoscopy. World J Gastroenterol 2010; 16: 3905-3910
• 31 Rastogi A et al. Higher adenoma detection rates with cap-assisted colonoscopy: a randomized controlled trial. Gut 2012; 61: 402-408
• 32 Horiuchi A, Nakayama Y, Kajiyama M et al. Benefits and limitations of cap-fitted colonoscopy in screening colonoscopy. Digestive Diseases and Sciences 2012; (in press)
• 33 Kondo S, Yamaji Y, Warabe H et al. A randomized controlled tria evaluation the usefulness of a transparent hood attached to the tip of the colonoscope. Am J Gastroenterol 2007; 102: 75-81
• 34 Harada Y, Hirsawa D et al. Impact of a transparent hood on the performance of total colonoscopy: a randomized controlled trial. Gastrointest Endosc 2009; 69: 637-644
• 35 de Wijkerslooth TR, Stoop EM, Bossuyt PM et al. Adenoma detection with cap-assisted colonoscopy versus regular colonoscopy: a randomized controlled trial. Gut 2012; 61: 1426-1434
• 36 Frieling T, Neuhaus F, Heise J et al. Cap-assisted colonoscopy (CAC) significantly extends visualization in the right colon. Z Gastroenterol 2012; 50: 279-284
• 37 Brenner H, Chang-Claude J, Seiler CM et al. Interval cancers after negative colonoscopy: population-based case control study. Gut 2012; 61: 1576-1582
• 38 Vemulapalli KC, Rex DK. Evolving techniques in colonoscopy. Curr Opin Gastroenterol 2011; 27: 430-438
• 39 Rex DK, Petrini JL, Baron TH et al. Quality indicators for endoscopy. Am J Gastroenterol 2006; 101: 873-885
• 40 Park SM, Lee SH, Shin KY et al. The cap-assisted technique enhances colonoscopy training: prospective randomized study of six trainees. Surg Endosc 2012; 26: 2939-2943
• 41 Ng SC, Tsoi KK, Hirai HW et al. The efficiacy of cap-assisted colonoscopy in polyp detection and cecal intubation: a meta-analysis of randomized controlled trials. Am J Gastroenterol 2012; 107: 1165-1173