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).
Copyright © 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.