Can cap-assisted colonoscopy be a savior for right side interval cancer?

摘要

There is no doubt that effective colorectal cancer screening relies on early identification and removal of polyps with neoplastic potential [1,2]. Although colonoscopy is regarded as the best method for detecting colonic neoplasm, it does have limitations. Right-sided lesions, flat polyps, and variable detection of endoscopist adenoma are all reasons why polyps are missed and interval cancers develop after a negative screening colonoscopy. Successful colorectal cancer protection by colonoscopy depends on complete intubation of the colon combined with careful and complete visualization of the colonic mucosal surface on withdrawal. A large population-based study showed that failure to intubate the cecum is not uncommon, especially for less experienced endoscopists; it was estimated to occur in 13.1 % of attempted colonoscopies [3]. Furthermore, occurrence of missed adenoma ranging from 13 to 26 % has been reported [4]. Adenoma detection has been shown to be an independent predictor of the risk of interval colorectal cancer after screening colonoscopy [5]. Several types of new technology have therefore been developed to improve adenoma detection, including high-definition white-light colonoscopy, pan-chromoendoscopy, wide-angle colonoscopy, virtual chromoendoscopy, third-eye retroscopy (TER), and cap-assisted colonoscopy (CAC) [6].