A prospective international multisite randomized controlled trial of water exchange with and without distal cap(s) in adenoma detection

Felix W. Leung; Sergio Cadoni; Long Chen; Yu Chen; Chi-Liang Cheng; Ramsey Cheung; Vivek Dixit; David Elashoff; Shai Friedland; Paolo Gallittu; Yu-Hsi Hsieh; Chia Hsin Cheng; Noam Jacob; Nora Jamgotchian; Hui Jia; Yen-Lin Kuo; Bai-Ping Lee; Joseph W. Leung; Donatella Mura; Jennifer Yi-Jiun Pan; Yanglin Pan; Susan Y. Quan; Angshuman Saha; Aliya Shaikh; James Sul; Chih-Wei Tseng; Yi-Ning Tsui; Holly Wilhalme; Robert J. Wong; Andrew W. Yen; Linhui Zhang

Authors Felix W. Leung, Sergio Cadoni, Long Chen, Yu Chen, Chi-Liang Cheng, Ramsey Cheung, Vivek Dixit, David Elashoff, Shai Friedland, Paolo Gallittu, Yu-Hsi Hsieh, Chia Hsin Cheng, Noam Jacob, Nora Jamgotchian, Hui Jia, Yen-Lin Kuo, Bai-Ping Lee, Joseph W. Leung, Donatella Mura, Jennifer Yi-Jiun Pan, Yanglin Pan, Susan Y. Quan, Angshuman Saha, Aliya Shaikh, James Sul, Chih-Wei Tseng, Yi-Ning Tsui, Holly Wilhalme, Robert J. Wong, Andrew W. Yen, Linhui Zhang.

Abstract

Background Interval cancers are linked to a low adenoma detection rate (ADR), prompting calls for benchmark-guided ADR performance improvement. Although water exchange and a straight cap (CAP) have been reported to independently improve ADR, the effects of Daisycuff™ and Endocuff Vision® remained unknown. We hypothesized that selected cap(s) could increase ADR and related water exchange outcomes.

Methods Subjects were randomized to No cap, or CAP, Daisycuff™ and Endocuff Vision® at 7, 5 and 2 sites. The primary outcome was ADR. Outcomes were compared for No cap vs. the above randomized caps.

Results Demographic and historic data revealed adequate randomization. Despite variations in sitespecific pretrial ADR, the aggregated data showed that the ADR of No cap (45.6%) exceeded the latest benchmark (35%). Each added cap increased the ADR, and the difference using Daisycuff™(52.8%) approached statistical significance (P=0.05). In the right colon, CAP and Daisycuff™ significantly increased ADR. In the left colon, Daisycuff™ significantly increased adenoma per colonoscopy. Factors that improved adenoma detection were consistent with published reports. Detection rates based on site, indication, sedation type, polyp size, shape and pathology in the No cap group were consistent with conventional data and were not influenced by the caps.

Conclusions The significantly higher right-colon ADRs with CAP and Daisycuff™ suggest potential clinical relevance for reducing interval cancers. Although water exchange with or without caps yields ADRs that surpass the benchmark, the positive findings for selected cap(s) need to be confirmed in order to enhance the options for further improvement of water exchange.

Keywords Water exchange colonoscopy, distal cap, adenoma detection rate

Ann Gastroenterol 2026; 39 (1): 104-1