Department of Gastroenterology, Veterans Affairs Medical Center, White River Junction, Vermont, USA.
Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Endoscopy. 2015 Oct;47(10):891-7. doi: 10.1055/s-0034-1392261. Epub 2015 Jun 30.
Cap-assisted colonoscopy has improved adenoma detection in some but not other studies. Most previous studies have been limited by small sample sizes and few participating endoscopists. The aim of the current study was to evaluate whether cap-assisted colonoscopy improves adenoma detection in a two-center, multi-endoscopist, randomized trial.
Consecutive patients who presented for an elective colonoscopy were randomized to cap-assisted colonoscopy (4-mm cap) or standard colonoscopy performed by one of 10 experienced endoscopists. Primary outcome measures were mean number of adenomas per patient and adenoma detection rate (ADR). Secondary outcomes included procedural measures and endoscopist variation; a logistic regression model was employed to examine predictors of increased detection with cap use.
A total of 1113 patients (64 % male, mean age 62 years) were randomized to cap-assisted (n = 561) or standard (n = 552) colonoscopy. The mean number of adenomas detected per patient in the cap-assisted and standard groups was similar (0.89 vs. 0.82; P = 0.432), as was the ADR (42 % vs. 40 %; P = 0.452). Cap-assisted colonoscopy achieved a faster cecal intubation time (4.9 vs. 5.8 minutes; P < 0.001), a similar cecal intubation rate (99 % vs. 98 %; P = 0.326), and a higher terminal ileum intubation rate (93 % vs. 89 %; P < 0.028). Cap-assisted colonoscopy resulted in a 20 % increase in ADR for some endoscopists and in a 15 % decrease for others. Individual preference for the cap was an independent predictor of increased adenoma detection in adjusted analysis (P < 0.001), whereas baseline low adenoma detection was not.
Although the efficiency of cecal and terminal ileum intubation was slightly improved by cap-assisted colonoscopy, adenoma detection was not. Cap-assisted colonoscopy may be beneficial for selected endoscopists.
clinicalTrials.gov (NCT01935180).
在一些研究中，帽辅助结肠镜检查提高了腺瘤的检出率，但在其他研究中则不然。大多数先前的研究受到样本量小和参与内镜医师少的限制。本研究旨在评估帽辅助结肠镜检查是否能提高两家中心、多内镜医师、随机试验中的腺瘤检出率。
连续因择期结肠镜检查而就诊的患者被随机分为帽辅助结肠镜组（4-mm 帽）或标准结肠镜组，由 10 名经验丰富的内镜医师之一进行操作。主要结局指标为每位患者平均腺瘤数和腺瘤检出率（ADR）。次要结局指标包括操作措施和内镜医师差异；采用逻辑回归模型检查使用帽后检出率增加的预测因素。
共 1113 例患者（64%为男性，平均年龄 62 岁）被随机分为帽辅助组（n=561）或标准组（n=552）。帽辅助组和标准组每位患者检出的腺瘤平均数量相似（0.89 与 0.82；P=0.432），ADR 也相似（42%与 40%；P=0.452）。帽辅助结肠镜检查的盲肠插管时间更快（4.9 与 5.8 分钟；P<0.001），盲肠插管率相同（99%与 98%；P=0.326），回肠末端插管率更高（93%与 89%；P<0.028）。对于某些内镜医师，帽辅助结肠镜检查的 ADR 增加了 20%，而对于其他内镜医师则减少了 15%。在调整分析中，对帽的个人偏好是 ADR 增加的独立预测因素（P<0.001），而基线低腺瘤检出率则不是。
尽管帽辅助结肠镜检查略微提高了盲肠和回肠末端插管的效率，但腺瘤的检出率并没有提高。帽辅助结肠镜检查可能对某些内镜医师有益。
clinicalTrials.gov（NCT01935180）。
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