Transparent cap colonoscopy versus standard colonoscopy to improve caecal intubation
Jenna Morgan, Kathryn Thomas, Heather Lee-Robichaud, Richard L Nelson, Sarah Braungart, Jenna Morgan, Kathryn Thomas, Heather Lee-Robichaud, Richard L Nelson, Sarah Braungart
Abstract
Background: Colonoscopy is considered the gold-standard investigation for screening and diagnosis of colorectal cancer. It is also becoming increasingly desirable for assessment, management, diagnosis and follow-up of other colorectal diseases, such as inflammatory bowel diseases and acute diverticulitis. Hence, due to the increasing demand for colonoscopy, devices to advance examination techniques are highly sought-after and the colonoscope with the transparent cap could be one of these.
Objectives: To identify and review all relevant data in order to determine whether colonoscopy with a transparent cap is a more effective diagnostic tool than colonoscopy.
Search methods: We searched the MEDLINE, EMBASE and CINAHL databases, and the Cochrane Central Register of Controlled Trials for all randomised controlled trials (RCTs) comparing the use of colonoscopy with a transparent cap with standard colonoscopy.
Selection criteria: Studies were included if they were randomised controlled trials which compared the use of colonoscopy with a transparent cap with standard colonoscopy.
Data collection and analysis: Data on study methods, participants, interventions used and outcomes measured was extracted from each study. Data was entered into the Cochrane Review Manager software (RevMan 5.0, 2008) and analysed using Cochrane MetaView.
Main results: In the present meta-analysis, we considered 14 randomised controlled trials so far published. The findings of our work indicate that colonoscopy with transparent cap has a faster caecal intubation time when compared with standard colonoscopy. Reviewing studies individually would also seem to favour colonoscopy with transparent cap for polyp detection rate and pain during procedure but due to lack of comparable data meta-analysis was not feasible.
Authors' conclusions: This review suggests that a transparent cap on the end of the colonoscope may give a marginally faster caecal intubation time compared with standard colonoscopy. It also suggests that there is a better polyp detection rate and less pain with the cap. However, the authors feel that further randomised controlled trials in this area would provide more clinically significant information on this adjunct to colonoscopy.
Conflict of interest statement
None
Figures
References
References to studies included in this review Choi 2009 {published data only}
- Choi DH, Shin HK, Lee YC, Lim CH, Jeong SK, Lee S‐H, et al. Efficacy of Transparent Cap‐attached Colonoscopy: Does It Improve the Quality of Colonoscopy?. J Korean Soc Coloproctol 2009;26(2):116‐22.
- Dai J, Feng N, Lu H, Li XB, Yang CH, Ge ZZ. Transparent cap improves patients' tolerance of colonoscopy and shortens examination time by inexperienced endoscopists.. Journal of digestive diseases 2010;11:264‐368.
- Wijkerslooth TR, Stoop EM, Bossuyt PM, Mathus‐Vliegen EMH, Dees J, Tytgat KMAJ, et al. Adenoma detection with cap‐assisted colonoscopy versus regular colonoscopy: a randomised controlled trial. Gut [e‐publication ahead of print] 2011 Dec 20.
- Harada Y, Hirasawa D, Fuijita N, Noda Y, Kobayashi G, Ishida K, Yonechi M, Ito K, Suzuki T, Sugawara T, Horaguchi J, Takasawa O, Obana T, Oohira T, Onochi K, Kanno Y, Kuroha M, Iwai W. Impact of a transparent hood on the performance of total colonoscopy: a randomised controlled trial.. Gastrointestinal Endoscopy 2009;69:637‐644.
- Hewett DG, Rex DK. Cap‐fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss rates. Gastrointestinal Endoscopy 2010;72:775‐781.
- Horiuchi A, Nakayama Y. Improved Colorectal Adenoma Detection With a Transparent Retractable Extension Device. American Journal of Gastroenterology 2008;103:341‐345.
- Kondo S, Yamaji Y, Watabe H, Yamada A, Sugimoto T, Ohta M, et al. A Randomized Controlled Trial Evaluating the Usefulness of a Transparent Hood Attached to the Tip of the Colonoscope. American Journal of Gastroenterology 2007;102:75‐81.
- Lee YT, Lai LH, Hui AJ, Wong VW, Ching JY, Wong GL, et al. Efficacy of cap‐assisted colonoscopy in comparison with regular colonoscopy: a randomized controlled trial. American Journal of Gastroenterology 2009;104:41‐46.
- Matsushita K, Hajiro K, Okazaki K, Takakuwa H, Tominaga M. Efficacy of Total Colonoscopy with a Transparent Cap in Comparison with Colonoscopy without the Cap. Endoscopy 1998;30(5):444‐7.
- Park SY, Kin HS, Yoon KW, Cho SB, Lee WS, Park CH, et al. Usefulness of cap‐assisted colonoscopy during colonoscopic EMR: A randomized controlled trial.. Gastrointestinal Endoscopy 2011;74:869‐875.
- Rastogi A, Bansal A, Rao DS, et al. Higher adenoma detection rates with cap‐assisted colonoscopy: a randomised controlled trial. Gut 2012;16:402‐408.
- Shida T, Katsuura Y, Teramoto O, Kaiho M, Takano S, Yoshidome H, et al. Transparent hood attached to the colonoscope: does it really work for all types of colonoscopes?. Surgical Endoscopy 2008;22(12):2654‐8.
- Tada M, Inoue H, Yabata E, Okabe S, Endo M. Feasibility of the Transparent Cap‐Fitted Colonoscope for Screening and Mucosal Resection. Diseases of the Colon and Rectum 1997;40(5):618‐621.
- Tee HP, Corte C, Al‐Ghamdi H, Prakoso E, Darke J, Chettiar R, et al. Prospective randomized controlled trial evaluating cap‐assisted colonoscopy vs standard colonoscopy.. World Journal of Gastroenterology 2010;16:3905‐3910.
- Dafnis G. Technical Considerations and Patient Comfort in Total Colonoscopy with and without a Transparent Cap: Intial Experiences from a Pilot Study.. Endoscopy 2000;32(5):381‐384.
- Horiuchi A, Nakayama Y. Is hood‐assisted colonoscopy more effective than narrow band imaging for colorectal adenoma detection?. Gastrointestinal Endoscopy. 2009; Vol. 69:AB130.
- Hyun LJ. Clinical usefulness of cap fitted colonoscopy in inexperienced colonoscopist: A randomized Controlled study. Journal of Gastroenterology and Hepatology. 2010; Vol. 25, issue (Suppl 2):A23‐A78.
- Hyun YS, Han DS, Bae JH, Park HS, Ahn SB, Kim TY, et al. A randomized tandem colonoscopy trial of transparent hood attached versus conventional examination to compare polyp miss rate.. Gastrointestinal Endoscopy 2010;71(5):AB332.
- Inoue T, Abe S‐Y, Murano M, Umegaki E, Higuchi K. Recommendation of a newly developed slit‐and‐hole‐type elastic hood for detection of more colon polyps.. Journal of Gastroenterology 2008;43:809‐810.
- Jeong JY, Han DS, Yu YH, Hyun YS, Bae JH, Park HS, et al. A randomized tandem colonoscopy trial of transparent hood attached versus conventional examination to compare polyp miss rate.. Journal of Gastroenterology and Hepatology 2010;25(suppl 2):A46.
- Jung SH, Park SJ, Park MI, Moon W, Kim HH. Efficacy of transparent cap‐fitted colonoscopy in cecal intubation time and detection of lesions compared with non‐cap fitted colonoscopy.. Journal of Gastroenterology and Hepatology 2011;26(suppl 5):59.
- Lee JS, Choi SH, Choi SW, Park HS, Kwak SD, Hwang S. Efficacy of hood‐cap associated colonoscopy: Comparison with regular colonoscopy, prospective study. . Gastrointestinal Endoscopy.. 2011; Vol. 73, issue 4S:AB410.
- Mamula P, Tierney WM, Banerjee S, Desilets D, Diehl DL, Farraye FA, et al. Devices to improve colon polyp detection.. Gastrointestinal Endoscopy 2011;73:1092‐1097.
- Moon W, Park SJ, Song JY, Park MI, Kim KJ. The Usefulness of Total Colonoscopy with a Transparent Cap. Gastroenterology 2008;134(suppl 1):A319 –A320.
- Nakamura H, Fu K, Yamamura A. A Magnifying gastroscopy using a soft black hood for difficult colonoscopy. Surgical Endoscopy and Other Interventional Techniques 2011;25:3016‐3021.
- Park SH, Jung M‐K, Jeon S, Kim S‐K. The cap assisted technique enhances the colonoscopy training; a randomized prospective study.. Gastrointestinal Endoscopy. 2011; Vol. 73:4S.
- Sato K, Hirahata K, Furuhata T, Kakemura T, Fujinuma S, Maetani I. Efficacy of oblique transparent cap with colonoscope for trainees analyzed with magnetic endoscope imaging (MEI): A preliminary report.. Gastrointestinal Endoscopy 2009;69(5):AB120.
- Takano N, Yamaji Y, Kajiwara H, et al. A randomized controlled trial of the usefulness of cap‐fitted colonoscopy on the polyp detection. Gastrointest Endosc 2008;67:AB303..
- Tee H‐P, Corte C, Al‐Ghamdi H, Prakoso E, Chettier R, Darke J, et al. A prospective randomized controlled trial evaluating cap‐assisted colonoscopy versus standard colonoscopy ‐ A western experience.. Journal of Gastroenterology and Hepatology 2009;24(suppl 2):A250‐251.
- Thomas RA, Rao DS, Gupta N, Gaddam S, Wani SB, Singh V, et al. Does cap‐assisted colonoscopy (CAC) significantly impact surveillance interval recommendations compared to standard colonoscopy (SC)? Results from a randomized controlled trial.. Gastrointestinal Endoscopy 2011;73(suppl 4):AB287.
- Yeung TM, Mortensen NJ. Advances in endoscopic visualization of colorectal polyps. Colorectal Disease 2011;13:352‐359.
- Ando T, Nishio Y, Watanabe O, Takahashi H, Maeda O, Ishiguro K, et al. Value of colonoscopy for prediction of prognosis in patients with ulcerative colitis. World Journal of Gastroenterology 2008;14(14):2133‐8.
- Axelrad AM, Fleischer DE, Geller AJ, Nguyen CC, Lewis JH, Al‐Kawas FH, et al. High‐resolution chromoendoscopy for the diagnosis of diminutive colon polyps: implications for colon cancer screening. Gastroenterology 1996;110:1253‐8.
- Bat L, Williams CB. Usefulness of pediatric colonoscopes in adult colonoscopy. Gastrointestinal Endoscopy 1991;37:152‐4.
- Baxter N, Goldwasser M, Paszat L, et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med 2009;150:1‐8.
- Benson AB 3rd. Epidemiology, disease progression, and economic burden of colorectal cancer. Journal of Managed Care Pharmacy 2007;13(6 Suppl C):S5‐18.
- Bressler B, Paszat LF, Vinden C, Li C, He J, Rabeneck L. Colonoscopic miss rates for right‐sided colon cancer: A populations‐based analysis. Gastroenterology 2004;127:452‐6.
- Chui H, Chang CY, Chen CC, Lee YC, Wu MS, Lin JT, et al. A prospective comparative study of narrow‐band imaging, chromoendoscopy and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut 2007;56:373‐379.
- Church J, Delany C. Randomized, controlled trial of carbon dioxide insufflation during colonoscopy. Diseases of the Colon and Rectum 2003;46(3):322‐325.
- Consolo P, Luigiano C, Strangio G, Scaffidi MG, Giacobbe G, Giuseppe G, et al. Efficacy, risk factors and complications of endoscopic polypectomy: Ten year experience at a single centre. World Journal of Gastroenterology 2008;14(15):2364‐2369.
- Cotton PB, Williams CB. Colonoscopy. In: Cotton PB, Williams CB editor(s). Practical Gastrointestinal Endoscopy. Oxford: Blackwell Scientific, 1990:160‐223.
- Deenadayalu V, Chadalawada V, Rex D. 170º wide‐angle colonoscope: effect on efficiency and miss rates. American Journal of Gastroenterology 2004;99(11):2138‐2142.
- Friedman S, Rubin PH, Bodian C, Goldstein E, Harpaz N, Present DH. Screening and surveillance colonoscopy in chronic Crohn's colitis. Gastroenterology 2001;120:820‐826.
- Goto H, Oda Y, Murakami Y, Tanaka T, Hasuda K, Goto S, et al. Proportion of de novo cancers among colorectal cancers in Japan. Gastroenterology 2006;131:40‐6.
- Han Y, Uno Y, Munakata A. Does flexible small‐diameter colonoscope reduce insertion pain during colonoscopy. World Journal of Gastroenterology 2000;6(5):659‐663.
- Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, et al. Randomised controlled trial of faecal‐occult‐blood screening for colorectal cancer. Lancet 1996;348:1472‐7.
- Higgins JPT, Green S (editors). Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0. 5.0.0 edition. The Cochrane Collaboration, 2008, updated February 2008.. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration, 2008.
- Hixson LJ, Fennerty MB, Sampliner RE, McGee D, Garewal H. Prospective study of the frequency and size distribution of polyps missed by colonoscopy. Journal of the National Cancer Institute 1990;82:1769‐72.
- Hurlstone DP, Cross SS, Slater R, Sanders DS, Brown S. Detecting diminutive colorectal lesions at colonoscopy: a randomized controlled trial of pan‐colonic versus targeted chromoscopy. Gut 2004;53:376‐380.
- Hurlstone DP, Brown S. Techniques for targeting screening in ulcerative colitis. Postgraduate Medical Journal 2007;83(981):451‐60.
- Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. The New England Journal of Medicine 2000;343:169‐74.
- Iishi H, Tatsuta M, Tsutsui S, Imanishi K, Otani T, Okuda S, et al. Early depressed adenocarcinomas of the large intestine. Cancer 1992;69:2406‐10.
- Kanamori T, Itoh M, Yokoyama Y, Takeuchi T. Endoscopic and clinicopathologic evaluation of four cases of minute flat invasive colorectal carcinoma. Gastrointestinal Endoscopy 1995;41:75‐9.
- Kobayashi K, Sivak MV. Flat adenoma: are western colonoscopists careful enough?. Endoscopy 1998;30:487‐489.
- Kondon S, Yamaji Y, Watabe H, Yamada A, Sugimoto T, Ohta M, et al. A Randomized Controlled Trial Evaluating the Usefulness of a Transparent Hood Attached to the Tip of the Colonoscope. American Journal of Gastroenterology 2007;102:75‐81.
- Kronborg O, Fenger C, Olsen J, Jørgensen OD, Søndergaard O. Randomized study of screening for colorectal cancer with faecal‐occult blood test. Lancet 1996;348:1467‐71.
- Kudo S, Tamure S, Nakajima T, Hirota S, Asano M, Ito O, et al. Depressed type of colorectal cancer. Endoscopy 1995;27:54‐7.
- Lahat A, Yanai H, Sakhnini E, Menachem Y, Bar‐Meir S. Role of colonoscopy in patients with persistent acute diverticulitis. World Journal of Gastroenterology 2008;14(17):2763‐6.
- Lapalus MG, Helbert T, Napoleon B, Rey JF, Houcke P, Ponchon T, et al. Does chromoendoscopy in association with high‐resolution video endoscopy improve colorectal adenomas diagnosis by colonoscopy?. Gastrointestinal Endoscopy 2004;59(5):147.
- Rhun M, Coron E, Parlier D, Nguyen J, Canard J, Alamdari A, et al. High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection of colonic neoplasia: a randomized study. Clinical Gastroenterology and Hepatology 2006;4(3):349‐354.
- Lee YT, Hui AJ, Wong VW, Hung LC, Sung JJ. Improved colonoscopy success rate with a distally attached mucosectomy cap. Endoscopy 2006;38:739‐42.
- Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. The New England Journal of Medicine 2000;343:162‐8.
- Lichenstein GR, Cohen LB, Uribarri J. Review article: bowel preparation for colonoscopy ‐ the importance of adequate hydration. Alimentary Pharmacology and Therapeutics 2006;26:633‐641.
- Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. The New England Journal of Medicine 1993;328:1365‐1371.
- Marshall JB. Use of paediatric colonoscope improves the success of total colonoscopy in selected adult patients. Gastrointestinal Endoscopy 1996;44:675‐8.
- Matsumoto T, Lida M, Kuwano Y, Tada S, Yao T, Fujishima M. Small nonpolypoid neoplastic lesions of the colon: endoscopic features with emphasis on their progression. Gastrointestinal Endoscopy 1995;41:135‐40.
- Matsushita M, Hajiro K, Okazaki K, Takakuwa H, Tominaga M. Total colonoscopy with a transparent cap. Endoscopy 1997;30:444‐7.
- Matsushita M, Danbara N, Fukui T, Matsumoto T, Uchida K, Omiya M, et al. Total colonoscopy with a transparent hood for trainees. American Journal of Gastroenterology 2007;102(10):2355‐6.
- Muto T, Bussey H, Morson BC. The evaluation of cancer of the colon and rectum. Cancer 1975;36:2251‐70.
- Newcomb PA, Storer BE, Morimoto LM, Templeton A, Potter JD. Long‐term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. Journal of the National Cancer Institute 2003;95:622‐625.
- Ng SC, Tsoi KK, Hirai HW, Wu JC, Chan FKL, Sung JJ, et al. CAP‐assisted colonoscopy versus standard colonoscopy in polyp detection and cecal intubation outcomes: A meta‐analysis of randomised‐controlled trials.. Gastrointestinal Endoscopy 2011;73(suppl 4):AB388.
- Quinn M, Babb P, Brock A, Kirby L, Jones J. Cancer Trends in England and Wales 1950‐1999. Studies on Medical and Population Subjects. Vol. No 66, Stationery Office, 2001.
- Rainis T, JKeren D, Goldstein O, Stermer E, Lavy A. Diagnostic yield and safety of colonoscopy in Israeli patients in an open access referral system. Journal of Clinical Gastroenterology 2007;41(4):394‐399.
- Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, et al. Colonoscopic miss rates of adenomas determined by back‐to‐back colonoscopies. Gastroenterology 1997;112:24‐8.
- Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S, Buckley JS. Relative sensitivity of colonoscopy and barium enema for detection colorectal cancer in clinical practice. Gastroenterology 1997;112:17‐23.
- Rex DK, Johnson DA, Lieberman DA, Burt RW, Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. American College of Gastroenterology. American Journal of Gastroenterology 2000;95:868‐77.
- Rex DK. Maximising detection of adenomas and cancer during colonoscopy. American Journal of Gastroenterology 2006;101(12):2866‐2877.
- Stolte M, Bethke B. Colorectal mini‐de novo carcinoma: A reality in Germany too. Endoscopy 1995;27:286‐90.
- Suzuki T, Matsushima M, Ihara K, Tokiwa K, Kania T, Ito A, et al. Clinical significance of the use of magnetic endoscope imaging for colonoscopy. Digestive Endoscopy 2004;16(4):322‐326.
- Svensson MH, Svensson E, Lasson A, Hellstrom M. Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease. Radiology 2002;222:337‐345.
- Thiis‐Evensen E, Hoff GS, Sauar J, Langmark F, Majak BM, Vatn MH. Population‐based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scandinavian Journal of Gastroenterology 1999;34:414‐420.
- Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, Deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: a systematic review. American Journal of Gastroenterology 2006;101:343‐50.
- Westwood DA, Alexakis N, Connor SJ. Transparent Cap‐Assisted Colonoscopy Versus Standard Adult Colonoscopy: A Systematic Review and Meta‐Analysis. Dis Colon and Rectum 2012;55:218‐225.
- Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. New England Journal of Medicine 1993;329:1977‐81.
- Winawer SJ, Zauber AG, O'Brien MJ, Ho MN, Gottlieb L, Sternberg SS, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. New England Journal of Medicine 1993;328:901‐6.
- Wolfe WI, Shinya H. Endoscopic polypectomy. Therapeutic and clinicopathologic aspects. Cancer 1975;36:683‐690.
- Yoshikawa I, Honda H, Nagata K, Kanda K, Yamasaki T, Kume K, et al. Variable stiffness colonoscopes are associated with less pain during colonoscopy in unsedated patients. American Journal of Gastroenterology 2004;97(12):3052‐3055.
Source: PubMed