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

Desai_headshotPost written by Madhav Desai, MD, MPH, from the University of Kansas Medical Center.

Proximal or right-sided colon lesions are often missed even after a meticulous screening colonoscopy and can often contribute to interval colon cancer. Cap-attached colonoscopy has the potential to increase yield in the right side of colon. Our goal was to assess role of cap colonoscopy (CC) in improving right-sided adenoma detection rate compared to standard colonoscopy (SC).

Colon cancer is a leading cause of death in the US, and our efforts at screening or surveillance are still sub-optimal. Current evidence demonstrates a large difference in colon cancer occurrence and detection on right side compared to left side of colon. Location could affect treatment choice and overall survival, with right-side colon cancer having poor outcomes. Studies have shown that polyps/adenomas are more commonly missed in the proximal or right-sided colon during colonoscopy which progress to CRC over time. We need to do a better job at finding these lesions and removing them. Cap-assisted colonoscopy is one step in this direction, and the current study provides rates of right-sided adenoma detection and other clinically useful parameters from a pooled analysis.


Figure 2. Forest plot of right-sided adenoma detection rate using cap-assisted colonoscopy versus standard colonoscopy. CI, Confidence interval.

Use of cap colonoscopy significantly improves the proximal colon adenoma detection rate and can potentially find more right-sided colonic lesions compared to standard colonoscopy.  In addition, flat adenoma and serrated colonic lesion detection rates are also significantly higher as compared to standard colonoscopy. Approximately 17 cap-assisted colonoscopies would be required to detect an additional patient with right-sided adenoma. Cap colonoscopy also improves detection rate of diminutive polyps (</=5mm) in the colon compared to standard colonoscopy.

Use of cap is simple, cheap, convenient, does not require specific training, and can be easily implemented to increase visualization and yield in right side of the colon.

Find the article abstract here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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