Introduction: Controversy remains regarding transparent cap-assisted technique improves adenoma detection rate (ADR) in colonoscopy. We aimed to investigate the effect of transparent cap-assisted colonoscopy (CAC) on ADR and other colonoscopy performance. Methods: We performed subanalysis of an international, multicenter, open-label database containing colonoscopy data from 11 centers in 4 Asian countries/regions on patients who underwent colonoscopy. The patient characteristics, procedure-related characteristics, and pathological findings of all detected lesions were prospectively recorded. The patients were divided into 2 groups as receiving colonoscopy with or without transparent cap attachment. The ADR and procedure time were compared between the 2 groups. Other procedural factors related to ADR were also investigated. Results: Between November 2020 and January 2022, 3,029 who underwent colonoscopy (transparent CAC, n = 1,796; standard colonoscopy, n = 1,233) were enrolled in this study. The transparent CAC group ADR was significantly higher than the conventional colonoscopy (55.1% vs. 50.0%, p < 0.01). Transparent CAC detected a higher proportion of patients with adenoma (odd ratio [OR]: 1.59, 95% CI: 1.13–2.24, p < 0.01) and any polypoid lesion (OR: 1.49, 95% CI: 1.04–2.16, p = 0.03). Transparent CAC also reduced cecal intubation time (mean difference: −0.35 min) and total colonoscopy time (mean difference −3.4 min). In the other procedural factors, using linked-color imaging (OR: 1.75, 95% CI: 1.49–2.06, p < 0.01), patient body rotation (OR: 1.54, 95% CI: 1.12–2.13, p < 0.01), longer withdrawal time (OR: 1.12, 95% CI: 1.09–1.15, p < 0.01) were also significantly associated to adenoma detection. Conclusion: In real-world practice, transparent CAC is a safe and inexpensive technology that could improve adenoma and polyp detection.

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