Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection: A Network Meta-analysis

Facciorusso, Antonio; Prete, Valentina Del; Buccino, Rosario Vincenzo; Valle, Nicola Della; Nacchiero, Maurizio Cosimo; Monica, Fabio; Cannizzaro, Renato; Muscatiello, Nicola

doi:10.1016/j.cgh.2017.11.007

Cited by 73 publications

(82 citation statements)

References 51 publications

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“…Conversely, in 35% < ADR < 45% and ADR > 45%, EAC appeared no benefits over SC. Thus it can be concluded that EndoCuff may be more helpful for operators with a low level rather than a high level of ADR, which was consistent with the previous studies . Operators with low level of ADR are mainly trainees or endoscopists with poor operating habits (eg, withdrawing too quickly or not observing carefully) who may easily miss the lesions hiding behind folds and large curves of flexures.…”

Section: Discussioncontrasting

confidence: 62%

“…Three meta‐analyses have been performed to confirm the effect of EndoCuff . Fewer studies were included in the early meta‐analysis, and most of these articles were of low quality.…”

Section: Introductionmentioning

confidence: 99%

“…Three meta-analyses have been performed to confirm the effect of EndoCuff. [14][15][16] Fewer studies were included in the early meta-analysis, and most of these articles were of low quality. The most recent metaanalysis 16 including 10 RCTs and two tandem studies concluded that EAC could improve ADR, especially for operators with low-to-moderate ADR.…”

Section: Introductionmentioning

confidence: 99%

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EndoCuff‐assisted colonoscopy could improve adenoma detection rate: A meta‐analysis of randomized controlled trials

Jian

Feng

Zhang

et al. 2019

J of Digest Diseases

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Objective This meta‐analysis aimed to evaluate whether EndoCuff‐assisted colonoscopy (EAC) could improve adenoma detection rate (ADR) compared with standard colonoscopy (SC). Methods PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar databases were searched for articles published up to March 2019. All pure randomized controlled trials comparing ADR between EAC and SC groups were included. Dichotomous data were pooled to obtain the odds ratio with a 95% confidence interval (CI), whereas continuous data were pooled using a mean difference with 95% CI. Review Manager Version 5.3 was used for data analysis. Results Thirteen randomized controlled trials consisting of 9038 patients (EAC: 4574; SC: 4464) were included. The EAC group showed significant superiority over the SC group in ADR (odds ratio 1.37, 95% CI 1.15–1.62). However, there were no differences between the EAC and SC groups in adverse events, cecal intubation rate, and cecal intubation time. Conclusions EAC could significantly improve ADR without increasing adverse events, especially for operators with low ADRs. In addition, no significant difference was observed in cecal intubation time and cecal intubation rate between EAC and SC.

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Section: Discussioncontrasting

confidence: 62%

“…Three meta‐analyses have been performed to confirm the effect of EndoCuff . Fewer studies were included in the early meta‐analysis, and most of these articles were of low quality.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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EndoCuff‐assisted colonoscopy could improve adenoma detection rate: A meta‐analysis of randomized controlled trials

Jian

Feng

Zhang

et al. 2019

J of Digest Diseases

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“…A network meta-analysis by Facciorusso et al reported that distal attachment devices, including caps, Endocuff, and EndoRings, increased ADR compared with SC (relative risk, 1.13; 95% confidence interval, 1.03-1.23), with low-quality evidence. 38 A meta-analysis of EAC versus SC including four randomized controlled trials, four retrospective cohort studies, and one prospective observational study showed that the ADR was significantly higher in the EAC group than in the SC group. 31 Another recent meta-analysis of EAC versus SC including 12 randomized controlled trials showed that the ADR and polyp detection rate were significantly higher in the EAC group than in the SC group, and the MAP tended to be higher with EAC.…”

Section: Discussionmentioning

confidence: 99%

Randomized control trial of adenoma detection rate in Endocuff‐assisted colonoscopy versus transparent hood‐assisted colonoscopy

Imaeda

Yamaoka

Ohgo

et al. 2019

J of Gastro and Hepatol

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Background and Aim Transparent hood‐assisted colonoscopy (TAC) has been reported to improve the cecal insertion rate and adenoma detection rate (ADR). An endoscopic cap (Endocuff) with two rows of soft wings was recently developed to improve ADR, by flattening the mucosal folds during withdrawal. This randomized prospective control study aimed to compare ADR between Endocuff‐assisted colonoscopy (EAC) and TAC. Methods A total of 513 patients undergoing colon adenoma screening were included. EAC was performed in 256 patients and TAC in 260 patients. Cecal intubation rate, cecal intubation time, ADR, and mean adenoma number per patient (MAP) were investigated in both groups (clinical trial registration: UMIN000016278). Results We excluded six patients in the EAC group and two patients in the TAC group because of colonic stenosis due to colonic adenocarcinomas. Finally, 250 patients (151 men/99 women, median age 62.1 years) were assigned to EAC and 258 patients (165 men/93 women, median age 64.3 years) were assigned to TAC. There were no significant differences in cecal intubation rate, intubation time, withdrawal time, and cleanliness score between groups. The ADR was 50.8% in EAC and 52.7% in TAC, with no significant difference (P = 0.666). The MAP was 1.35 in EAC and 1.20 in TAC, with no significant difference (P = 0.126). However, The MAP of diminutive adenomas (< 5 mm) tended to be higher in EAC than in TAC (P = 0.077). There was no significant difference in MAP in each segment between groups. Conclusions Endocuff‐assisted colonoscopy might be equivalent to TAC in cecal intubation time, ADR, and MAP.

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“…However, larger multicenter randomized controlled trials (RCT) have not shown a consistent benefit for enhanced adenoma detection 1 and a further study has shown ADR to be numerically worse with EAC. 2 Faccioruso et al 3 performed a network metanalysis of 25 different RCTs comparing add-on devices with ADR as the primary endpoint. This analysis found a modest advantage for EAC over standard colonoscopy (low quality evidence).…”

mentioning

confidence: 99%

Distal attachments for adenoma detection go head‐to‐head: Cap or cuff?

Lahiff

East

2019

J of Gastro and Hepatol

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Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection: A Network Meta-analysis

Abstract: Based on network meta-analysis, we anticipate only modest improvement in ADRs with use of distal attachment devices, especially in low-performing endoscopists.

Cited by 73 publications

References 51 publications

EndoCuff‐assisted colonoscopy could improve adenoma detection rate: A meta‐analysis of randomized controlled trials

EndoCuff‐assisted colonoscopy could improve adenoma detection rate: A meta‐analysis of randomized controlled trials

Randomized control trial of adenoma detection rate in Endocuff‐assisted colonoscopy versus transparent hood‐assisted colonoscopy

Distal attachments for adenoma detection go head‐to‐head: Cap or cuff?

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