Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.6098
Peer-review started: May 19, 2020
First decision: May 29, 2020
Revised: June 2, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: October 21, 2020
The design of colonic transendoscopic enteral tubing (TET) requires repeated colonoscopies, which increase procedure time and potential procedure-related risks. It is uncertain whether cap-assisted colonoscopy (CC) would facilitate the technical performance after inserting the TET tube into the intestinal lumen during the TET procedure.
We conducted a multicenter, prospective, and randomized controlled trial to ascertain whether CC could decrease the second cecal intubation time and bring potential benefits compared with regular colonoscopy (RC) during TET.
The aim of this study was to compare CC with RC in the second cecal intubation time among subjects undergoing colonic TET.
This trial was performed at four centers. Subjects ≥ 7 years needing colonic TET were recruited from August 2018 to January 2020. All subjects were randomly assigned to the RC (n = 165) or CC (n = 166) group. Baseline characteristics including age, sex, body mass index, previous abdominal or pelvic surgery, and disease category were collected before colonic TET. The primary outcome was the second cecal intubation time. The secondary outcomes included TET success rate, maximum insertion pain score, single clip fixation time, purpose and retaining time of TET tube, length of TET tube inserted into the colon, and all procedure-related (serious) adverse events.
The median time of the second cecal intubation was significantly shorter for the CC group than RC (2.2 min vs 2.8 min; P < 0.001). In constipation patients, the median time of the second cecal intubation in group of CC (n = 50) was shorter than RC (n = 43) (2.6 min vs 3.8 min; P = 0.004). However, no difference was observed in the groups of CC (n = 42) and RC (n = 46) in ulcerative colitis patients (2.0 min vs 2.5 min; P = 0.152). The insertion pain score during the procedure in the group of CC (n = 14) was lower than that in RC (n = 19) in unsedated colonoscopies (3.8 ± 1.7 vs 5.4 ± 1.9; P = 0.015). Multivariate analysis revealed that only CC (OR = 2.250, 95%CI: 1.161-4.360; P = 0.016) was an independent factor affecting the second cecal intubation time in difficult colonoscopy. CC did not affect the colonic TET tube retention time and the length of the tube inserted into the colon. Moreover, multivariate analysis found that only endoscopic clip number (OR = 2.201, 95%CI: 1.541-3.143; P < 0.001) was an independent factor affecting the retention time. Height (OR = 1.144, 95%CI: 1.027-1.275; P = 0.014) was the only independent factor influencing the length of TET tube inserted into the colon in adults by multiple regression analysis.
CC for the colonic TET procedure is a safe and less painful technique which is able to save the cecal intubation time. Importantly, CC does not affect the safety and stability of the TET tube.
Further studies are needed in children aged 3-7 years and the Western population.