Cap assisted colonoscopy for the detection of serrated polyps: a post-hoc analysis

Background: Colonoscopy offers limited protection against right-sided colon cancer, a significant proportion of which arise from the serrated pathway of carcinogenesis. The aim of this study was to compare cap-assisted colonoscopy and standard high-definition white light colonoscopy regarding serrated polyps' detection. Methods: Post hoc analysis was performed of a previously conducted randomized controlled trial comparing standard and cap-assisted colonoscopy for adenoma detection. Randomization was stratified based on the indication of colonoscopy and all procedures were performed by three experienced endoscopists. Following cecal intubation, the colonic mucosa was carefully inspected during withdrawal of colonoscope and all polyps detected were documented for their size, location, morphology and then removed and sent for histopathology. Detection rates of significant serrated polyps between both arms were compared using the Fisher's exact test and Wilcoxon Rank Sum test. Results: 427 patients were enrolled (7 exclusions, 210 completed study in each arm, mean age of 61 years, 95% male, 75% Caucasian, 67% screening colonoscopies). There were no significant differences in baseline characteristics between both groups. Cap-assisted colonoscopy detected a significantly higher proportion of subjects with significant serrated polyps as well as a higher total number of significant serrated polyps compared to standard colonoscopy (12.8% vs. 6.6%, p = 0.047 and 40 vs. 20, p = 0.03 respectively). Conclusions: In this post-hoc analysis, Cap-assisted colonoscopy is a safe technique that offers a higher detection rate of significant serrated polyps when compared to standard colonoscopy. If confirmed in future trials, this simple technique has the potential to improve protection against interval colon cancers.