Cap Assisted Upper Endoscopy for Examination of the Major Duodenal Papilla: A Randomized, Blinded, Controlled Crossover Study (CAPPA Study)

• Published in: The American journal of gastroenterology Vol. 112; no. 5; pp. 725 - 733
• Main Authors: Abdelhafez, Mohamed, Phillip, Veit, Hapfelmeier, Alexander, Elnegouly, Mayada, Poszler, Alexander, Strobel, Kilian, Born, Peter, Dollhopf, Markus, Kassem, Abdel Meguid, Calavrezos, Lenika, Klare, Peter, Schlag, Christoph, Bajbouj, Monther, Schmid, Roland M, von Delius, Stefan
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.05.2017
• Subjects: Adult; Ampulla of Vater - diagnostic imaging; Clinical Competence; Cross-Over Studies; Endoscopy, Gastrointestinal - instrumentation; Female; Gastroenterology; Gastrointestinal Diseases - diagnostic imaging; Humans; Incidental Findings; Male; Middle Aged; Operative Time; Prospective Studies; Single-Blind Method
• ISSN: 0002-9270; 1572-0241; 1572-0241
• DOI: 10.1038/ajg.2017.47

Examination of major duodenal papilla (MDP) by standard forward-viewing esophagogastroduodenoscopy (S-EGD) is limited. Cap assisted esophagogastroduodenoscopy (CA-EGD) utilizes a cap fitted to the tip of the endoscope that can depress the mucosal folds and thus might improve visualization of MDP. The aim of this study was to compare CA-EGD to S-EGD for complete examination of the MDP. Prospective, randomized, blinded, controlled crossover study. Subjects scheduled for elective EGD were randomized to undergo S-EGD (group A) or CA-EGD (group B) before undergoing a second examination by the alternate method. Images of the MDP were evaluated by three blinded multicenter-experts. Our primary outcome measure was complete examination of the papilla. Secondary outcome measures were duration and overall diagnostic yield. A total of 101 patients were randomized and completed the study. Complete examination of MDP was achieved in 98 patients using CA-EGD compared to 24 patients using S-EGD (97 vs. 24%, P<0.001). Median duration from intubation of the esophagus until localization of the MDP was shorter with CA-EGD (46. vs. 96 s., P<0.001). In group A, 11 extra lesions and 12 additional incidental findings were detected by secondary CA-EGD, whereas neither were detected by secondary S-EGD in group B (22 vs. 0% and 24 vs. 0%, P<0.001 and P<0.001). CA-EGD enabled complete examination of MDP in almost all cases compared to a low success rate of S-EGD. CA-EGD detected a significant amount of lesions and incidental findings when added to S-EGD. CA-EGD is a safe and effective method for examination of MDP.