Effect of combined cap-assisted, water-aided, and prone position colonoscopy for adenoma detection: A retrospective study

Background The efficacy of cap-assisted, water-aided, and 12 o’clock-prone position colonoscopy as individual techniques for adenoma detection is well documented. However, the efficacy of the combination of the three colonoscopy methods is unclear. Therefore, the present study aimed to retrospectively compare the efficacy between combined-method colonoscopy (CMC) and standard colonoscopy (SC). Methods and Findings A total of 746 patients who underwent either CMC or SC, performed by two board-certified gastroenterologists between December 2019 and March 2020 at Baekyang Jeil Internal Medicine Clinic, were retrospectively evaluated. We evaluated polyp detection rate (PDR), adenoma detection rate (ADR), and mean number of adenomas detected per procedure (MAP). Statistical analysis for comparison between the groups was performed using the Student’s t-test, and ADR and PDR were analyzed using Fisher’s exact test. The study population was predominantly women (55.4%). The mean patient age (standard deviation) was 62.87 (±7.83) years. There was no significant difference in sex, number of fecal occult blood test-positive patients, and age between the two groups. The PDR, ADR, and proximal colon MAP were significantly higher in the CMC group than in the SC group (PDR: 59.8% vs. 84.9%, p < 0.001; ADR: 49.2% vs. 70.1%, p < 0.001; proximal colon MAP: 0.55 vs. 1.24, p < 0.001). Conclusions Compared with SC, CMC increases PDR, ADR, and MAP, especially proximal colon MAP. Therefore, CMC may be more useful than SC in clinical settings. This study is the first to evaluate the efficacy of the three techniques in combination.