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

Hewett, David G. and Rex, Douglas K. (2010) Cap-fitted colonoscopy: A randomized, tandem colonoscopy study of adenoma miss rates. Gastrointestinal Endoscopy, 72 4: 775-781. doi:10.1016/j.gie.2010.04.030

Author Hewett, David G.
Rex, Douglas K.
Title Cap-fitted colonoscopy: A randomized, tandem colonoscopy study of adenoma miss rates
Journal name Gastrointestinal Endoscopy   Check publisher's open access policy
ISSN 0016-5107
Publication date 2010-10
Sub-type Article (original research)
DOI 10.1016/j.gie.2010.04.030
Volume 72
Issue 4
Start page 775
End page 781
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Formatted 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.

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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: ERA 2012 Admin Only
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 59 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 63 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 24 Oct 2011, 17:00:16 EST by System User on behalf of School of Medicine