Improved colorectal adenoma detection with a transparent retractable extension device

BACKGROUND AND AIMS: Colonoscopy is an excellent but imperfect modality for colorectal cancer screening and prevention. We studied the effects of a retractable transparent extension device on adenoma detection rate as well as on intubation and withdrawal times. METHODS: Colonoscopy with or without the transparent retractable extension (TRE) was performed by one endoscopist. A subset of patients with colonic adenomas were randomized to repeat colonoscopy with or without a TRE device. Adenoma removal was done at the second colonoscopy. The principal outcome parameters were the cecal intubation time, withdrawal time, and the number, size, and location of adenomas detected. RESULTS: The study was done in two parts. First, 835 patients underwent colonoscopy with or without the TRE. The patients' demographic characteristics, the indications for colonoscopy, the cecal intubation time and withdrawal time, and the proportion of patients with adenomas (29.0% Vs 24.1%) (P = 0.11) were similar between the two techniques. The number of adenomas detected with the TRE was significantly higher than that without the extension (205 vs 150) (P = 0.04). Second, 60 patients with adenomas found at colonoscopy without the device were randomized to repeat colonoscopy within 3 months. Hood-assisted colonoscopy revealed 20% more adenomas than the initial procedure compared to a 4% increase without the hood (P = 0.029). CONCLUSIONS: Colonoscopy with a TRE device improved the adenoma detection rate without affecting intubation and withdrawal times.