Department of Gastroenterology & Hepatology , Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
Gut. 2012 Oct;61(10):1426-34. doi: 10.1136/gutjnl-2011-301327. Epub 2011 Dec 20.
Conventional colonoscopy (CC) is considered the reference standard for detection of colorectal neoplasia, but it can still miss a substantial number of adenomas. The use of a transparent plastic cap may improve colonic visualisation. Cap-assisted colonoscopy (CAC) was compared with CC for adenoma detection. Secondary outcomes were caecal intubation time, caecal intubation rate and the degree of discomfort of colonoscopy.
This is a parallel, randomised, controlled trial at two centres. Asymptomatic participants (aged 50-75 years) in a primary colonoscopy screening programme were consecutively invited. Consenting subjects were 1:1 randomised to either CAC or CC. All colonoscopies were performed by experienced endoscopists (≥ 1000 colonoscopies) who were trained in CAC. Colonoscopy quality indicators were prospectively recorded.
A total of 1380 participants were randomly allocated to CC (N=694) or CAC (N=686). Caecal intubation rate was comparable in the two groups (98% vs 99%; p=0.29). Caecal intubation time was significantly lower in the CAC group: 7.7 ± 5.0 min with CAC vs 8.9 ± 6.2 min with CC (p<0.001) (values mean ± SD). Adenoma detection rates of all endoscopists were ≥ 20%. The proportion of subjects with at least one adenoma was similar in the two groups (28% vs 28%; RR 0.98; 95% CI 0.82 to 1.16), as well as the mean number of adenomas per subject (0.49 ± 1.05 vs 0.50 ± 1.03; p=0.91). Detection of small size, flat and proximally located adenomas was comparable. CAC participants had lower Gloucester Comfort Scores during colonoscopy (2.2 ± 1.0 vs 2.0 ± 1.0; p=0.03).
CAC does not improve adenoma detection, but does reduce caecal intubation time by more than 1 min and does lessen the degree of discomfort during colonoscopy.
传统结肠镜检查（CC）被认为是结直肠肿瘤检测的参考标准，但仍可能遗漏大量腺瘤。使用透明塑料帽可改善结肠可视化。对比 CAP 辅助结肠镜检查（CAC）与 CC 在腺瘤检测方面的效果。次要结果是盲肠插管时间、盲肠插管率和结肠镜检查的不适程度。
这是在两个中心进行的平行、随机、对照试验。连续邀请参加初级结肠镜筛查计划的无症状参与者（年龄 50-75 岁）。同意的受试者按 1:1 随机分为 CAC 或 CC 组。所有结肠镜检查均由经验丰富的内镜医师（≥1000 例结肠镜检查）进行，这些医师接受过 CAC 培训。前瞻性记录结肠镜检查质量指标。
共有 1380 名参与者被随机分配至 CC（n=694）或 CAC（n=686）组。两组盲肠插管率相当（98%对 99%；p=0.29）。CAC 组的盲肠插管时间明显更短：CAC 组为 7.7±5.0min，CC 组为 8.9±6.2min（p<0.001）（值为均数±标准差）。所有内镜医师的腺瘤检出率均≥20%。两组的腺瘤检出率相似（28%对 28%；RR 0.98；95%CI 0.82 至 1.16），每个患者的平均腺瘤数也相似（0.49±1.05 对 0.50±1.03；p=0.91）。对小尺寸、平坦和近端腺瘤的检出率相当。CAC 组患者在结肠镜检查期间的 Gloucester 舒适度评分较低（2.2±1.0 对 2.0±1.0；p=0.03）。
CAC 不会提高腺瘤的检出率，但可将盲肠插管时间缩短 1 分钟以上，并减轻结肠镜检查期间的不适程度。
