Cap-fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss rates - 24/08/11
Reprint requests: Douglas K. Rex, MD, Indiana University Hospital #4100, 550 N. University Boulevard, Indianapolis, IN 46202Riassunto |
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)
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : CFC
Mappa
| DISCLOSURE: D.K. Rex disclosed a consultant relationship with Olympus America, Inc. No other financial relationships relevant to this publication were disclosed. |
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| See CME section; p. 802 |
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| If you would like to chat with an author of this article, you may contact Dr Rex at drex@iupui.edu. |
Vol 72 - N° 4
P. 775-781 - ottobre 2010 Ritorno al numero
Articolo precedente
- Diving deeper into the small bowel: a comparison of spiral and single-balloon enteroscopy
- Andrew S. Ross
- Reducing adenoma miss rates during colonoscopy: time to put our thinking caps on?
- Douglas G. Adler
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