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.

中文翻译：

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使用固定帽的帽辅助染色内镜检查与用于腺瘤检测的标准结肠镜检查

目的 一些肿瘤性病变在结肠镜检查中仍未被发现。迄今为止，还没有研究调查将帽辅助结肠镜检查与色素内镜检查相结合是否会提高腺瘤检出率 (ADR)。本研究旨在比较帽辅助色素内镜 (CAP/CHROMO) 与标准结肠镜 (SC) 在检测腺瘤方面的功效。方法这项前瞻性、多中心、随机对照试验包括年龄在 45-75 岁之间、在 14 家大学医院首次接受结肠镜检查的无症状受试者。受试者被随机分配到 CAP/CHROMO 组（使用结肠镜尖端的帽式导管喷洒 0.09% 靛蓝胭脂红）或 SC 组。所有息肉均被切除，但仅考虑组织学证实的肿瘤性病变进行分析。主要结果是 ADR，定义为至少有 1 个腺瘤的受试者比例。结果 在 14 个中心，共有 1,905 名受试者被随机分配到 CAP/CHROMO（n = 948）或 SC（n = 957）组。两组受试者的人口统计学特征相似。CAP/CHROMO 组的 ADR 显着高于 SC 组（54.4% vs 44.9%，P < 0.001）。值得注意的是，CAP/CHROMO (38.6%) 比 SC (31.2%) 识别出更多患有至少 1 个近端结肠腺瘤的受试者 (P = 0.001)。CAP/CHROMO 的近端锯齿状息肉检出率在女性亚组中显着高于 SC。然而，CAP/CHROMO 和 SC 组之间的晚期 ADR 没有差异（9.3% 对 7.6%，P = 0.180）。讨论 CAP/CHROMO 显着改善了 ADR 并增强了近端腺瘤的检测。