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Prospective randomized controlled trial evaluating cap-assisted colonoscopy vs standard colonoscopy

World Journal of Gastroenterology 2010年第31期16卷 3905-3910页

作者： Hoi-Poh Tee Crispin Corte Hamdan Al-Ghamdi Emilia Prakoso john darke Raman Chettiar Wassim Rahman Scott Davison Sean P Griffin Warwick S Selby Arthur J Kaffes Gastroenterology Unit Medical DepartmentHospital Tengku Ampuan AfzanJalan Tanah Putih25100 KuantanPahang Malaysia AW Morrow Gastroenter-ology and Liver Centre Royal Prince Alfred HospitalMissen-den RoadCamperdownNSW 2050Australia Gastroenterology Unit Medical DepartmentQueen Elizabeth HospitalKarung Berkunci No.202988586 Kota KinabaluMalaysia

AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. RESULTS: There were 200 cases in each group. There was no signif icant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no signif icant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 ± 7.05 min vs 10.34 ± 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 ± 13.95 min vs 22.56 ± 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003),

关键词： Cap Hood Cecum Colonoscopy Cecal intubation Colonic polyps

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