Efficacy of Cap-Assisted Colonoscopy in Comparison With Regular Colonoscopy: A Randomized Controlled Trial

Lee, Yuk Tong; Lai, Lihui; Hui, Aric Josun; Wong, Vincent W. S.; Ching, Jessica; Wong, Grace Lai Hung; Wu, Justin Che Yuen; Chan, Henry Lik Yuen; Leung, Wai Keung; Lau, James Y.; Sung, Joseph J.Y.; Chan, Francis K.L.

doi:10.1038/ajg.2008.56

Cited by 117 publications

(117 citation statements)

References 19 publications

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“…Characteristics pertaining to past history included abdominal and/or pelvic surgery 8,12,30,31 , diagnosed left-sided diverticulosis 31 , incomplete colonoscopy (due to redundant colon, difficult sigmoid or difficult sedation) 32 , unsatisfactory (poor) bowel preparation 33 and irritable bowel syndrome 31 . Characteristics associated with current colonoscopy included difficult anatomy 28 , patient pain or discomfort 28,30 , symptoms of inflammatory bowel diseases 12 , prolonged insertion time (>480 sec), technically difficult insertion 12 , lower gastrointestinal bleeding 24 , obstructing malignancy 28 , severe inflammation 28 , poor bowel preparation 12,28,30 , failure to reach the cecum 34,35 , unsedated colonoscopy 3,18,21,22,36 and colonoscopy following gastroscopy 31 . Methods reported to minimize patient discomfort or enhance cecal intubation during colonoscopy were reviewed 37 and included the use of pediatric colonoscope, variable stiffness colonoscope, gastroscope, computer assisted colonoscope, magnetic endoscope imaging, hypnosis, patient inhalation of nitrous oxide, listening to music, distraction by audio stimuli, or simply allowing the patients to participate in administration of the sedation medication.…”

Section: Discussionmentioning

confidence: 99%

“…Repeat bowel preparation and next day colonoscopy 33 has been proposed as a suitable approach to deal with those with failed cecal intubation due to poor bowel preparation, and naturally incurs another bowel purge and an additional visit. The transparent hood attached to the tip of the colonoscope reduced pain and enhanced cecal intubation was reviewed 37 but there was one subsequent report with conflicting data 35 . Use of a non standard small caliber overtube-assisted colonoscopy 41 has also been recommended.…”

Section: Discussionmentioning

confidence: 99%

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The water method is effective in difficult colonoscopy—it enhances cecal intubation in unsedated patients with a history of abdominal surgery

Leung¹,

Mann²,

Leung³

et al. 2011

jig

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Background: colonoscopy in unsedated patients in the Us is considered to be difficult. success rate of cecal intubation is limited by discomfort. colonoscopy in patients with a history of abdominal surgery is also considered to be difficult due to adhesion-related bowel angulations. The water method has been shown to significantly reduce pain during colonoscopy. Objective: To test the hypothesis that the water method enhances the completion of colonoscopy in unsedated patients with a history of abdominal surgery. Design: The data bases of two parallel RcT were combined and analyzed. Setting: Two Veterans affairs endoscopy units. Patient and Methods:The water and air methods were compared in these two parallel RcT examining unsedated patients. Those with a history of abdominal surgery were selected for evaluation. Main Outcome Measurements: completion of unsedated colonoscopy. Results: among patients with a history of abdominal surgery, the proportion completing unsedated colonoscopy in the water group (19 of 22) was significantly higher than that (11 of 22) in the air group (p=0.0217, Fisher's exact test). Limitations: small number of predominantly male veterans, unblinded colonoscopists, not all types of abdominal surgery (e.g. hysterectomy, gastrectomy) predisposing to difficult colonoscopy were represented. Conclusion: This proof-of-principle assessment confirms that in patients with a history of abdominal surgery the water method significantly increases the proportion able to complete unsedated colonoscopy. The water method deserves to be evaluated in patients with other factors associated with difficult colonoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The water method is effective in difficult colonoscopy—it enhances cecal intubation in unsedated patients with a history of abdominal surgery

Leung¹,

Mann²,

Leung³

et al. 2011

jig

View full text Add to dashboard Cite

show abstract

“…Distal = distal to the splenic flexure. definition, wide-angle endoscope 15,[21][22][23][24][25] ; narrow band imaging [26][27][28] ; transparent hood attached to the tip of the colonoscope 26,29,30 withdrawal time >6 min 31,32 or modified (e.g. split-dose) bowel preparation 33,34 .…”

Section: Discussionmentioning

confidence: 99%

The water method combined with chromoendoscopy enhances adenoma detection

Leung¹,

Ransibrahmanakul²,

Toomsen³

et al. 2011

jig

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Background:The water method is easy-to-learn and improves colonoscopy outcomes. Dye-spray chromoendoscopy enhances ADR but has not been widely accepted for routine application in screening or surveillance colonoscopy. Hypothesis: With dye added to the water used in the water method, ADR can be enhanced compared with the water or air method alone. Objective: To compare ADR determined by the air method, water method alone, and water method with indigo carmine (0.008%) added. Design: Review of prospectively collected data in a performance improvement program. Setting: VA endoscopy unit. Patient: Screening or surveillance colonoscopy. Methods: Patients (n=50/group) underwent colonoscopy with each of the three methods. Water method involved warm water infusion in lieu of air insufflation coupled with removal of residual air by suction and residual feces by water exchange. ADR and procedural data were collected prospectively to monitor performance. Main Outcome Measurements: ADR. Results: ADR in the air method, water method alone and water method with indigo carmine were 36%, 40% and 62%, respectively. Water method with indigo carmine produced significantly higher ADR than the air or water method alone (p<0.05). Limitations: Non-randomized data, single VA site, retrospective comparison. Absence of significant difference between air and water methods could be a type II error due to small number of patients Conclusions: The approach with indigo carmine added to the water used in the water method yielded significantly higher ADR than the water or the air method alone. The data suggest that a prospective RCT to compare the different methods is warranted.

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“…Many comparative studies of transparent hood (cap)-assisted colonoscopy with standard colonoscopy have been conducted; however, results have been varied. [17][18][19] A transparent hood may have some advantages not only for improving the ADR but also the cecal intubation rates. In addition, good bowel preparation is critical for capassisted colonoscopy as fecal material can adhere to the inside of the cap impairing the view, reducing the ADR, and prolonging procedure time.…”

Section: Transparent Hoodmentioning

confidence: 99%

Screening colonoscopy: What is the most reliable modality for the detection and characterization of colorectal lesions?

Matsuda

Kawano

Chiu

2015

Digestive Endoscopy

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Colonoscopy is considered the best modality for the detection and treatment of colorectal polyps. However, some polyps still may not be detected. Although conventional white‐light endoscopy is the gold standard for the detection of colorectal polyps, up to a fifth of lesions may be missed on screening colonoscopy, especially non‐polypoid colorectal neoplasms. Recently, many studies have reported on various endoscopic modalities that improve the detection and characterization of colorectal lesions. Newly developed modalities might be helpful to recognize colorectal lesions; however, careful observation is required to identify flat/depressed lesions as well as hidden polyps during screening and surveillance colonoscopy.

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Efficacy of Cap-Assisted Colonoscopy in Comparison With Regular Colonoscopy: A Randomized Controlled Trial

Cited by 117 publications

References 19 publications

The water method is effective in difficult colonoscopy—it enhances cecal intubation in unsedated patients with a history of abdominal surgery

The water method is effective in difficult colonoscopy—it enhances cecal intubation in unsedated patients with a history of abdominal surgery

The water method combined with chromoendoscopy enhances adenoma detection

Screening colonoscopy: What is the most reliable modality for the detection and characterization of colorectal lesions?

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