Efficacy of combination colonoscopy using modified cap-assisted and water-exchange colonoscopy with prone position for detection of colorectal adenomas.

The efficacy of cap-assisted and water-exchange colonoscopy, individually or in combination for adenoma detection is well documented. Moreover, prone positioning colonoscopy may also improve adenoma detection by decreasing loop formation. However, the efficacy of triple-combination colonoscopy using the above methods for adenoma detection is unclear. This study aimed to compare the effectiveness of combining modified cap-assisted and water-exchange colonoscopy with prone position (CWP) and conventional colonoscopy (CC) for adenoma detection. A total of 746 patients who underwent either CWP or CC, performed by 2 board-certified gastroenterologists between December 2019 and March 2020, were investigated retrospectively. Cap-assisted colonoscopy was modified using hooking and dragging maneuver. We evaluated the polyp detection rate (PDR), adenoma detection rate (ADR), and the mean number of adenomas detected per procedure (MAP). There was no significant difference in sex, age, the indication of colonoscopy and quality of bowel preparation between the 2 groups. PDR, ADR, and proximal colon MAP were significantly higher in the CWP group than in the CC group (PDR: 84.9% vs 59.8%, P < .01; ADR: 70.1%, vs 49.2%, P < .01; proximal colon MAP: 1.24 vs 0.55, P < .01). CWP is more effective than CC for PDR, ADR, and proximal colon MAP. Although it may facilitate adenoma detection, further studies assessing the synergistic or complementary effects of combining these methods are needed.