Impact of a transparent hood on the performance of total colonoscopy: a randomized controlled trial

Background: Clinical demand for total colonoscopy (TCS) is increasing. Improvement of the cecal intubation rate and shortening of the examination time would expand the capacity for TCS. Objective: To assess the efficacy of a transparent hood attached to the tip of a colonoscope for cecal intubation in TCS. Design: Prospective, randomized, controlled study. Setting: Single tertiary-referral center. Interventions: TCS. Main Outcome Measurements: Cecal intubation time and rate, complications, patient discomfort, and detection rate of colonic polyps. Methods: Patients who were to undergo screening and/or surveillance TCS for colorectal cancer were invited to participate in the study. Cecal intubation time and rate, complications, patient discomfort, and detection rate of colonic polyps were evaluated. Results: A total of 592 patients enrolled in this study were randomly allocated to the hood group and no-hood group. The mean (SD) cecal intubation time in the hood group and the no-hood group was 10.2 ± 12.5 minutes and 13.4 ± 15.8 minutes, respectively (P = .0241). The effect of its use was more prominent in the expert endoscopists group compared with those with moderate experience. The cecal intubation rate and the detection rate of small polyps in the 2 groups were similar. The grade of patient discomfort was significantly lower in the hood group. No complications were encountered with the use of the hood. Conclusions: Use of a transparent hood on the tip of a colonoscope shortened the time required for cecal intubation and decreased patient discomfort; such use was more effective among experts in shortening the examination time.