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Gastrointest Endosc. 2010 Oct;72(4):775-81. doi: 10.1016/j.gie.2010.04.030. Epub 2010 Jun 25.

Cap-fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss rates.

Author information

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).

PMID:
20579648
DOI:
10.1016/j.gie.2010.04.030
[Indexed for MEDLINE]
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