Prospective randomized controlled trial evaluating cap-assisted colonoscopy vs standard colonoscopy.

AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. RESULTS: There were 200 cases in each group. There was no significant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no significant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 +/- 7.05 min vs 10.34 +/- 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 +/- 13.95 min vs 22.56 +/- 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003), trainee-performed procedures (P = 0.01), usage of hyoscine (P = 0.01) and procedures performed for polyp follow-up (P = 0.01). The limitations of the study were that it was a single-center experience, no blinding was possible, and there were a large number of endoscopists. CONCLUSION: CAC did not significantly different from SC in term of cecal intubation time and polyp detection rate.

Evaluation of thermal acclimation capacity in corals with different thermal histories based on catalase concentrations and antioxidant potentials.

Colonies of Pocillopora damicornis from Kaneohe Bay and colonies of Pocillopora meandrina from a thermal outfall site and a control site at Kahe were exposed to three different temperatures (29, 32 and 33 degrees C) in outdoor aquaria on running water tables for five days. Samples (n=3) were taken from each treatment at 0800, 1200 and 1600 h. ELISAs using catalase antibodies and ferric reducing/antioxidant potential (FRAP) assays were run on the samples to determine how antioxidant levels changed throughout the experiment. Light levels during the experiment were highest in the morning ( approximately 1000-1500 micromol quanta m(-2) s(-1)) and decreased to 25-60 micromol quanta m(-2) s(-1) by 1100 h and remained low until sunset. Antioxidant concentrations were highest in the morning for P. damicornis from Kaneohe and P. meandrina outfall samples. There was no significant change through the day for P. meandrina samples from the control site. The difference in response between the outfall samples and the control samples suggests that P. meandrina has acclimated to elevated temperatures found at the outfall site.