Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials

Nutalapati, Venkat; Kanakadandi, Vijay; Desai, Madhav; Olyaee, Mojtaba; Rastogi, Amit

doi:10.1055/a-0650-4258

Cited by 29 publications

(24 citation statements)

References 39 publications

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“…Whereas an initial pooled analysis of 8 randomized controlled trials (RCTs) showed no significant differences, 7 high-quality RCT revealed a significant difference (OR 1.18, 95 % CI 1.03 – 1.33). However, the significance was only reached by removing 1 study 26 with a Jadad score of 1 from the initial 8 RCTs 1 ( Fig. 2a and Fig.…”

Section: What Is the Clinical Benefit Of Cc?mentioning

confidence: 98%

“…In this issue of Endoscopy , Nutalapati et al 1 try to overcome this dilemma by selecting only papers of high quality for their meta-analysis. Criteria for the “high quality” was a Jadad score ≥ 3 39 .…”

Section: What Is the Clinical Benefit Of Cc?mentioning

confidence: 99%

“…Nutalapati et al 1 further analyzed the benefit of the cap on cecal intubation rate and cecal intubation time.…”

Section: What Is the Clinical Benefit Of Cc?mentioning

confidence: 99%

“…Thus, is there enough evidence to incorporate CC in clinical practice? Interpreting the literature and the meta-analysis by Nutalapati et al 1 , the answer for the clinically focussed endoscopist with regard to ADR at present may be no. Significant differences do not necessarily imply clinical benefits and translation into clinical practice.…”

Section: What Is the Clinical Benefit Of Cc?mentioning

confidence: 99%

“…In this issue of Endoscopy , Nutalapati et al 1 present a meta-analysis on the performance of cap-assisted colonoscopy (CC) for adenoma detection rate (ADR) during standard colonoscopy (SC). By extensive literature search (Medline, Embase, Scopus, Cochrane and Web of Science databases, abstracts published at national meetings), they analyzed and included only high-quality studies with Jadad score ≥ 3.…”

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confidence: 99%

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Cap-assisted endoscopy: Do we have enough evidence?

Frieling

2018

Endosc Int Open

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So, is there enough evidence to incorporate CC in clinical practice? If we interpret the literature and the meta-analysis by Nutalapati et al., the answer for the clinically-focused endoscopist, with regard to adenoma detection rate (ADR), at present, may be “no”. Significant differences do not necessarily imply clinical benefits and translation into clinical practice. The answer for the improvement of cecal intubation frequency and intubation time by the cap depends on the focus of training commitment, because these effects of the cap may be beneficial, especially for unexperienced endoscopists. It is obvious that further studies are needed. In this line, it is interesting to know, that in a recent meta-analysis of prospective studies, the length of the transparent cap had opposite effects on investigation time and polyp detection rate. Whereas, the anal to cecal time was significantly shortened by a cap length of > 7 mm and a polyp detection rate was significantly improved by a cap length of < 4 mm.

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Section: What Is the Clinical Benefit Of Cc?mentioning

confidence: 98%

Section: What Is the Clinical Benefit Of Cc?mentioning

confidence: 99%

“…Nutalapati et al 1 further analyzed the benefit of the cap on cecal intubation rate and cecal intubation time.…”

Section: What Is the Clinical Benefit Of Cc?mentioning

confidence: 99%

Section: What Is the Clinical Benefit Of Cc?mentioning

confidence: 99%

mentioning

confidence: 99%

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Cap-assisted endoscopy: Do we have enough evidence?

Frieling

2018

Endosc Int Open

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Multicenter propensity score‐matched analysis comparing short versus long cap‐assisted colonoscopy for acute hematochezia

et al. 2023

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Background and Aim While short and long attachment caps are available for colonoscopy, it is unclear which type is more appropriate for stigmata of recent hemorrhage (SRH) identification in acute hematochezia. This study aimed to compare the performance of short versus long caps in acute hematochezia diagnoses and outcomes. Methods We selected 6460 patients who underwent colonoscopy with attachment caps from 10 342 acute hematochezia cases in the CODE BLUE‐J study. We performed propensity score matching (PSM) to balance baseline characteristics between short and long cap users. Then, the proportion of definitive or presumptive bleeding etiologies found on the initial colonoscopy and SRH identification rates were compared. We also evaluated rates of blood transfusions, interventional radiology, or surgery, as well as the rate of rebleeding and mortality within 30 days after the initial colonoscopy. Results A total of 3098 patients with acute hematochezia (1549 short cap and 1549 long cap users) were selected for PSM. The rate of colonic diverticular bleeding (CDB) diagnosis was significantly higher in long cap users (P = 0.006). While the two groups had similar rates of the other bleeding etiologies, the frequency of unknown etiologies was significantly lower in long cap users (P < 0.001). The rate of SRH with active bleeding was significantly higher in long cap users (P < 0.001). Other clinical outcomes did not differ significantly. Conclusion Compared to that with short caps, long cap‐assisted colonoscopy is superior for the diagnosis of acute hematochezia, especially CDB, and the identification of active bleeding.

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