Evaluation of the use of CAP in lower digestive tract endoscopies in terms of polyp detection rate (PDR) and adenoma detection rate (ADR).

Prospective registration of consecutive patients with lower GI endoscopy with or without the use of CAP. Demographic, clinical and endoscopic data (cleanliness, cecal catheterization, polyp detection) as well as the pathological result were recorded. Bowel cleanliness was assessed with the BBPS scale (Optimal: 9, Suboptimal: 6-8). All endoscopies were performed under conscious sedation by residents with supervision and/or assistance from specialists using high-resolution endoscopes (Olympus CF-H185L, CF-HQ190L) and CO₂ insufflation.

440 endoscopies were analyzed [(260F/180M, median age 63 years [(IQR 55-70)]. 87 (19.8%) without the use of CAP and 353 (80.2%) with the use of CAP. The mean BBPS value was 8.32±1.01 and there was no difference between optimal and suboptimal preparation between the 2 groups (with or without CAP). In total, polyps were found in 350 endoscopies with PDR 79.5% while in 228 endoscopies adenomas were found with ADR 51.8%. In the 353 endoscopies with the use of CAP, polyps were found in 289 (PDR:81.8%) and adenomas in 185 (ADR 52.4%) while in the 87 without the use of CAP, polyps were found in 61 (PDR 70.1%) and adenomas in 44 (ADR 50.6%). Statistical analysis (χ2 test) revealed that the use of CAP helped in the detection of polyps by significantly improving the PDR (OR=1.92, 95%CI: 1.13-3.28; p=0.015) but did not contribute to the detection of adenomas and therefore did not improve the ADR to statistically significant levels (OR 1.12, 95%CI: 0.7-1.8; p=0.61). In the univariate analysis, age was also significantly associated with PDR (p = 0.001), whereas sex, bowel preparation quality, and endoscopist experience (senior vs fellow) showed no significant associations. In the multivariable model adjusting for age, sex, bowel preparation quality, endoscopist experience, and bisacodyl use, cap-assisted colonoscopy remained an independent predictor of improved PDR (OR = 0.56, 95% CI: 0.34–0.95; p = 0.030). Bisacodyl use was also associated with higher PDR (p = 0.034), while sex, preparation quality, and endoscopist level showed no significant associations.

The use of CAP significantly improves polyp detection and remains an independent predictor of higher PDR after adjustment for key confounders, whereas it does not improve the ADR