GIE Associate Shimon Bar-Meir, MD, highlights this article from the December issue: “Efficacy of cap-assisted endoscopy for the visualization of the major duodenal papilla: a systematic review and meta-analysis” by Umair Iqbal, MD, et al.

Upper GI endoscopy does not visualize the major duodenal papilla well. Patients with familial adenomatosis polyposis are at an increased risk of duodenal adenomas or pathology of the papilla.

In such a population, there is a need for careful inspection of the papilla and better than with a forward-viewing endoscope. The American Society for Gastrointestinal Endoscopy has recommended a side-viewing endoscopy for this population.

However, in a community setting, such an endoscope is sometimes unavailable, and expertise in operating a side-viewing endoscope does not always exist. Some studies have suggested cap-assisted endoscopy for better inspection of the major duodenal papilla. It is a simple procedure that can be performed by all endoscopists who perform upper GI endoscopy.

This study by Iqbal et al is a meta-analysis based on publications that compare forward-viewing endoscopy with or without a cap with side-viewing endoscopy. The authors found that the best technique to thoroughly inspect the major duodenal papilla is by side-viewing endoscope, but cap-assisted endoscopy provides a good inspection of the papilla in 93% of patients.

It can be considered in a community setting, and only those where inspection of the papilla is inadequate should be referred for side-viewing endoscopy.

Visualization of the major duodenal papilla. A, Standard forward-facing endoscope. B, Cap-assisted forward-facing endoscope. C, Side-viewing duodenoscopy.

Read the full article online.

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