Suggestion of a standard maneuver in cap-assisted colonoscopy: hooking and dragging maneuver

Cap-assisted colonoscopy involves the attachment of a distal transparent cap to the end of the colonoscope. This method has several advantages, such as decreasing insertion time [1] and enabling easy flattening of the mucosal folds, thus permitting visualization of the hidden polyps behind the mucosal folds [2]. However, the use of cap-assisted colonoscopy in detecting adenomas is debatable [1] [3]. Until now, although the benefits of using a clear cap have been discussed, there have been no discussions on how to use it. Therefore, this study suggests a “hooking and dragging maneuver” ([Video 1]). This maneuver involves hooking the mucosal fold with the tip of the cap, dragging the scope, scratching along the colon wall, and stretching multiple mucosal folds simultaneously ([Fig. 1]). This technique allows the visualization of multiple posterior regions of the mucosal fold at the same time, minimizing the hidden areas. Hooking points and dragging directions on the cecum ([Fig. 2]), the ascending colon ([Fig. 3]), and the hepatic flexure ([Fig. 4]) are shown.

Video 1 “Hooking and dragging maneuver” as a standard maneuver in cap-assisted colonoscopy. Source for graphical illustration: Park Sabeom.

Fig. 1 Schematic diagram of “hooking and dragging maneuver”. Source: Park Sabeom.

Fig. 2 Mucosal hooking points on the cecum.

Fig. 3 Mucosal hooking points on the ascending colon.

Fig. 4 Mucosal hooking points on the hepatic flexure.

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Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Nutalapati V, Kanakadandi V, Desai M. et al. Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials. Endosc Int Open 2018; 6: E1214-E1223 DOI: 10.1055/a-0650-4258. [Epub 2018 Oct 8]
• 2 Kim HH, Park SJ, Park MI. et al. Transparent-cap-fitted colonoscopy shows higher performance with cecal intubation time in difficult cases. World J Gastroenterol 2012; 18: 1953-1958 DOI: 10.3748/wjg.v18.i16.1953.
• 3 Pohl H, Bensen SP, Toor A. et al. Cap-assisted colonoscopy and detection of adenomatous polyps (CAP): a randomized trial. Endoscopy 2015; 47: 891-897 DOI: 10.1055/s-0034-1392261.

Publication History

Article published online:
28 April 2021