OBJECTIVES:Some neoplastic lesions remain undetected on colonoscopy. To date, no studies have investigated whether combining cap-assisted colonoscopy with chromoendoscopy increases the adenoma detection rate (ADR). This study aimed to compare cap-assisted chromoendoscopy (CAP/CHROMO) with standard colonoscopy (SC) with respect to their efficacy in detecting adenomas.METHODS:This prospective, multicenter, randomized controlled trial included asymptomatic subjects aged 45-75 years who underwent colonoscopy for the first time at 14 university hospitals. Subjects were randomized to either the CAP/CHROMO group (with 0.09% indigo carmine spraying using a cap-mounted catheter at the tip of the colonoscope) or the SC group. All polyps were resected, but only histologically confirmed neoplastic lesions were considered for analysis. The primary outcome was ADR, defined as the proportion of subjects with at least 1 adenoma.RESULTS:A total of 1,905 subjects were randomized to the CAP/CHROMO (n = 948) or SC (n = 957) group at 14 centers. Subjects' demographic characteristics were similar between both groups. The CAP/CHROMO group had significantly higher ADR than the SC group (54.4% vs 44.9%, P < 0.001). Significantly, more subjects with at least 1 proximal colon adenoma were identified by CAP/CHROMO (38.6%) than by SC (31.2%) (P = 0.001). The proximal serrated polyp detection rate by CAP/CHROMO was significantly higher in the female subgroup vs SC. However, advanced ADR was not different between the CAP/CHROMO and SC groups (9.3% vs 7.6%, P = 0.180).DISCUSSION:CAP/CHROMO markedly improved the ADR and enhanced the detection of proximal adenoma. CAP/CHROMO is feasible for routine application and will allow for a more effective surveillance program.
|Number of pages||8|
|Journal||American Journal of Gastroenterology|
|Publication status||Published - 2020 Mar 1|
Bibliographical noteFunding Information:
Guarantor of the article: Hyun-Soo Kim, MD, PhD. Specific author contributions: Su Young Kim, MD, PhD and Hong Jun Park, MD, PhD, contributed equally to this work and are cofirst authors. S.Y.K. and H.J.P.: wrote the manuscript. H.-S.K.: contributed to the study concept and design. D.I.P., J.M.C., S.-J.P., H.C., J.E.S., C.S.E., J.O.K., H.G.K., S.-E.K., C.H.P., T.I.K., and S.N.H.: recruited patients and acquired material support for the study. Financial support: This study was supported by grants from the Korean Health Technology R&D Project (A102065-23) and the National R&D Program for Cancer Control (HA17C0046), Ministry of Health & Welfare, Republic of Korea. Potential competing interests: None to report.
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