Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis

Madhav Desai, Andre Sanchez-Yague, Abhishek Choudhary, Asad Pervez, Neil Gupta, Prashanth Vennalaganti, Sreekar Vennelaganti, Alessandro Fugazza, Alessandro Repici, Cesare Hassan, Prateek Sharma

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

BACKGROUND AND AIMS: Proximal colon adenomas can be missed during routine colonoscopy. Use of a cap or hood on the tip of the colonoscope has been shown to improve overall adenoma detection with variable rates. However, it has not been systematically evaluated for detection of proximal colon or right-sided adenomas where the cap may have maximum impact on adenoma detection rate (ADR). Our aim was to perform a systematic review and meta-analysis to evaluate the impact of cap-assisted colonoscopy (CC) on right-sided ADRs (r-ADRs) compared with standard colonoscopy (SC).

METHODS: PubMed, EMBASE, SCOPUS, and Cochrane databases as well as secondary sources (bibliographic review of selected articles and major GI proceedings) were searched through October 1, 2016. Primary outcome was the pooled rate of r-ADR. Detection of flat adenoma, sessile serrated adenoma/polyp (SSA/P), and number of right-sided adenomas per patient were also assessed. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using random-effect models.

RESULTS: We screened 686 records and analyzed data from 4 studies (CC group, 2546 patients; SC group, 2547 patients) that met criteria for determination of r-ADRs, whereas 6 studies (CC group, 3159 patients; SC group, 3137 patients) were analyzed to estimate right-sided adenomas per patient. r-ADR was significantly higher with CC compared with SC (23% vs 17%; OR, 1.49; 95% CI, 1.08-2.05; I2 = 79%; P = .01). CC also improved detection rates of flat adenoma (OR, 2.08; 95% CI, 1.35-3.20; P < .01) and SSA/P (OR, 1.33; 95% CI, 1.01-1.74; P = .04). The total number of right-sided adenomas (CC: 1428 [60%] vs SC: 1127 [58%]) and number of right-sided adenomas per patient (CC, .71 ± .5, vs SC, .65 ± .62 [mean ± standard deviation]) were numerically higher for CC but were not statistically significant (P = .43). Approximately 17 CCs would be required to detect an additional patient with right-sided adenoma.

CONCLUSIONS: Use of CC significantly improves the proximal colon ADR. In addition, flat adenoma and serrated colonic lesion detection rates are also significantly higher as compared with SC.

Original languageEnglish
Pages (from-to)274-281.e3
JournalGastrointestinal Endoscopy
Volume86
Issue number2
DOIs
Publication statusPublished - Aug 2017

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Colonoscopy
Adenoma
Meta-Analysis
Colon
Odds Ratio
Confidence Intervals
Polyps
Colonoscopes
Patient Rights
PubMed

Keywords

  • Journal Article
  • Review

Cite this

Desai, M., Sanchez-Yague, A., Choudhary, A., Pervez, A., Gupta, N., Vennalaganti, P., ... Sharma, P. (2017). Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis. Gastrointestinal Endoscopy, 86(2), 274-281.e3. https://doi.org/10.1016/j.gie.2017.03.1524

Impact of cap-assisted colonoscopy on detection of proximal colon adenomas : systematic review and meta-analysis. / Desai, Madhav; Sanchez-Yague, Andre; Choudhary, Abhishek; Pervez, Asad; Gupta, Neil; Vennalaganti, Prashanth; Vennelaganti, Sreekar; Fugazza, Alessandro; Repici, Alessandro; Hassan, Cesare; Sharma, Prateek.

In: Gastrointestinal Endoscopy, Vol. 86, No. 2, 08.2017, p. 274-281.e3.

Research output: Contribution to journalReview article

Desai, M, Sanchez-Yague, A, Choudhary, A, Pervez, A, Gupta, N, Vennalaganti, P, Vennelaganti, S, Fugazza, A, Repici, A, Hassan, C & Sharma, P 2017, 'Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis', Gastrointestinal Endoscopy, vol. 86, no. 2, pp. 274-281.e3. https://doi.org/10.1016/j.gie.2017.03.1524
Desai, Madhav ; Sanchez-Yague, Andre ; Choudhary, Abhishek ; Pervez, Asad ; Gupta, Neil ; Vennalaganti, Prashanth ; Vennelaganti, Sreekar ; Fugazza, Alessandro ; Repici, Alessandro ; Hassan, Cesare ; Sharma, Prateek. / Impact of cap-assisted colonoscopy on detection of proximal colon adenomas : systematic review and meta-analysis. In: Gastrointestinal Endoscopy. 2017 ; Vol. 86, No. 2. pp. 274-281.e3.
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title = "Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis",
abstract = "BACKGROUND AND AIMS: Proximal colon adenomas can be missed during routine colonoscopy. Use of a cap or hood on the tip of the colonoscope has been shown to improve overall adenoma detection with variable rates. However, it has not been systematically evaluated for detection of proximal colon or right-sided adenomas where the cap may have maximum impact on adenoma detection rate (ADR). Our aim was to perform a systematic review and meta-analysis to evaluate the impact of cap-assisted colonoscopy (CC) on right-sided ADRs (r-ADRs) compared with standard colonoscopy (SC).METHODS: PubMed, EMBASE, SCOPUS, and Cochrane databases as well as secondary sources (bibliographic review of selected articles and major GI proceedings) were searched through October 1, 2016. Primary outcome was the pooled rate of r-ADR. Detection of flat adenoma, sessile serrated adenoma/polyp (SSA/P), and number of right-sided adenomas per patient were also assessed. Pooled odds ratio (OR) and 95{\%} confidence intervals (CIs) were calculated using random-effect models.RESULTS: We screened 686 records and analyzed data from 4 studies (CC group, 2546 patients; SC group, 2547 patients) that met criteria for determination of r-ADRs, whereas 6 studies (CC group, 3159 patients; SC group, 3137 patients) were analyzed to estimate right-sided adenomas per patient. r-ADR was significantly higher with CC compared with SC (23{\%} vs 17{\%}; OR, 1.49; 95{\%} CI, 1.08-2.05; I2 = 79{\%}; P = .01). CC also improved detection rates of flat adenoma (OR, 2.08; 95{\%} CI, 1.35-3.20; P < .01) and SSA/P (OR, 1.33; 95{\%} CI, 1.01-1.74; P = .04). The total number of right-sided adenomas (CC: 1428 [60{\%}] vs SC: 1127 [58{\%}]) and number of right-sided adenomas per patient (CC, .71 ± .5, vs SC, .65 ± .62 [mean ± standard deviation]) were numerically higher for CC but were not statistically significant (P = .43). Approximately 17 CCs would be required to detect an additional patient with right-sided adenoma.CONCLUSIONS: Use of CC significantly improves the proximal colon ADR. In addition, flat adenoma and serrated colonic lesion detection rates are also significantly higher as compared with SC.",
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TY - JOUR

T1 - Impact of cap-assisted colonoscopy on detection of proximal colon adenomas

T2 - systematic review and meta-analysis

AU - Desai, Madhav

AU - Sanchez-Yague, Andre

AU - Choudhary, Abhishek

AU - Pervez, Asad

AU - Gupta, Neil

AU - Vennalaganti, Prashanth

AU - Vennelaganti, Sreekar

AU - Fugazza, Alessandro

AU - Repici, Alessandro

AU - Hassan, Cesare

AU - Sharma, Prateek

N1 - Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

PY - 2017/8

Y1 - 2017/8

N2 - BACKGROUND AND AIMS: Proximal colon adenomas can be missed during routine colonoscopy. Use of a cap or hood on the tip of the colonoscope has been shown to improve overall adenoma detection with variable rates. However, it has not been systematically evaluated for detection of proximal colon or right-sided adenomas where the cap may have maximum impact on adenoma detection rate (ADR). Our aim was to perform a systematic review and meta-analysis to evaluate the impact of cap-assisted colonoscopy (CC) on right-sided ADRs (r-ADRs) compared with standard colonoscopy (SC).METHODS: PubMed, EMBASE, SCOPUS, and Cochrane databases as well as secondary sources (bibliographic review of selected articles and major GI proceedings) were searched through October 1, 2016. Primary outcome was the pooled rate of r-ADR. Detection of flat adenoma, sessile serrated adenoma/polyp (SSA/P), and number of right-sided adenomas per patient were also assessed. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using random-effect models.RESULTS: We screened 686 records and analyzed data from 4 studies (CC group, 2546 patients; SC group, 2547 patients) that met criteria for determination of r-ADRs, whereas 6 studies (CC group, 3159 patients; SC group, 3137 patients) were analyzed to estimate right-sided adenomas per patient. r-ADR was significantly higher with CC compared with SC (23% vs 17%; OR, 1.49; 95% CI, 1.08-2.05; I2 = 79%; P = .01). CC also improved detection rates of flat adenoma (OR, 2.08; 95% CI, 1.35-3.20; P < .01) and SSA/P (OR, 1.33; 95% CI, 1.01-1.74; P = .04). The total number of right-sided adenomas (CC: 1428 [60%] vs SC: 1127 [58%]) and number of right-sided adenomas per patient (CC, .71 ± .5, vs SC, .65 ± .62 [mean ± standard deviation]) were numerically higher for CC but were not statistically significant (P = .43). Approximately 17 CCs would be required to detect an additional patient with right-sided adenoma.CONCLUSIONS: Use of CC significantly improves the proximal colon ADR. In addition, flat adenoma and serrated colonic lesion detection rates are also significantly higher as compared with SC.

AB - BACKGROUND AND AIMS: Proximal colon adenomas can be missed during routine colonoscopy. Use of a cap or hood on the tip of the colonoscope has been shown to improve overall adenoma detection with variable rates. However, it has not been systematically evaluated for detection of proximal colon or right-sided adenomas where the cap may have maximum impact on adenoma detection rate (ADR). Our aim was to perform a systematic review and meta-analysis to evaluate the impact of cap-assisted colonoscopy (CC) on right-sided ADRs (r-ADRs) compared with standard colonoscopy (SC).METHODS: PubMed, EMBASE, SCOPUS, and Cochrane databases as well as secondary sources (bibliographic review of selected articles and major GI proceedings) were searched through October 1, 2016. Primary outcome was the pooled rate of r-ADR. Detection of flat adenoma, sessile serrated adenoma/polyp (SSA/P), and number of right-sided adenomas per patient were also assessed. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using random-effect models.RESULTS: We screened 686 records and analyzed data from 4 studies (CC group, 2546 patients; SC group, 2547 patients) that met criteria for determination of r-ADRs, whereas 6 studies (CC group, 3159 patients; SC group, 3137 patients) were analyzed to estimate right-sided adenomas per patient. r-ADR was significantly higher with CC compared with SC (23% vs 17%; OR, 1.49; 95% CI, 1.08-2.05; I2 = 79%; P = .01). CC also improved detection rates of flat adenoma (OR, 2.08; 95% CI, 1.35-3.20; P < .01) and SSA/P (OR, 1.33; 95% CI, 1.01-1.74; P = .04). The total number of right-sided adenomas (CC: 1428 [60%] vs SC: 1127 [58%]) and number of right-sided adenomas per patient (CC, .71 ± .5, vs SC, .65 ± .62 [mean ± standard deviation]) were numerically higher for CC but were not statistically significant (P = .43). Approximately 17 CCs would be required to detect an additional patient with right-sided adenoma.CONCLUSIONS: Use of CC significantly improves the proximal colon ADR. In addition, flat adenoma and serrated colonic lesion detection rates are also significantly higher as compared with SC.

KW - Journal Article

KW - Review

U2 - 10.1016/j.gie.2017.03.1524

DO - 10.1016/j.gie.2017.03.1524

M3 - Review article

C2 - 28365356

VL - 86

SP - 274-281.e3

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 2

ER -