Cap Assisted Colonoscopy for the Detection of Serrated Polyps

Cap Assisted Colonoscopy for the Detection of Serrated Polyps

Results

Subjects and Procedural Characteristics

A total of 427 subjects were prospectively enrolled by 3 endoscopists in this randomized controlled trial between September 2009 and October 2010. Seven subjects were excluded (five due to failed cecal intubation, one due to inadequate bowel preparation, and one due to the diagnosis of Crohn's disease). Thus, a total of 420 patients (210 in each of the two arms) completed the study protocol (mean age of 61 years, 95% male, 75% Caucasian, 67% screening colonoscopies, 33% surveillance colonoscopies). Baseline characteristics of subjects in both study arms were similar like age, gender, race, smoking history, BMI, and family history of colon cancer. Successful cecal intubation was seen in the vast majority of cases (98% of procedures in the SC group as compared to 99% in the CAC group with p = 0.37). The mean insertion time was significantly shorter in the CAC group as compared to the SC group (3.29 +/− 2.55 min vs. 3.98 +/− 2.56 min, p < 0.001) and the terminal ileal intubation rate was higher in the CAC group (91% vs. 83%, p 0.018). On the other hand, the mean withdrawal time (5.95 ± 1.58 min in CAC vs 5.98 ± 1.45 min for standard colonoscopy, p = 0.75), bowel preparation quality, and sedation medication doses were not significantly different between the two groups.

Serrated Polyps Detection Rate

As outlined in Table 1, CAC detected higher total number of significant serrated polyps when compared to SC (40 vs 20; P 0.032). For subgroup analysis, CAC detected a higher number of SSA/P or TSA (7 vs 1, p 0.03). Although the number of proximal hyperplastic polyps (26 vs 14; P 0.1) and large hyperplastic polyps (12 vs 7; P 0.19) was numerically higher with CAC, the differences did not achieve statistical significance.

Similarly, the proportion of subjects with significant serrated polyps was higher in the CAC as compared to the SC group (13% vs 7%; P 0.047). For the subgroup analysis, the proportion of subjects with SSA/SSP or TSA, proximal HP, large HP, were numerically higher in the CAC compared to SC but these differences did not reach statistical significance for any subgroup (Table 2).