Effect of Endocuff use on colonoscopy outcomes: A systematic review and meta-analysis

Abstract

BACKGROUND Endocuff - a plastic device with flexible projections - mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection. AIM To elucidate the effect of Endocuff on adenoma detection rate (ADR), advanced ADR (AADR) and mean number of adenomas per colonoscopy (MAC). METHODS Literature searches identified randomized-controlled trials evaluating Endocuff-assisted colonoscopy (EAC) vs conventional colonoscopy (CC) in terms of ADR, AADR and MAC. The effect size on study outcomes was calculated using fixed or random effect model, as appropriate, and it is shown as relative risk (RR) [95% confidence interval (CI)] and mean difference (MD) (95%CI). The rate of device removal in EAC arms was also calculated. RESULTS We identified nine studies enrolling 6038 patients. All studies included mixed population (screening, surveillance and diagnostic examinations). Seven and two studies evaluated the first and the second-generation device, respectively. EAC was associated with increased ADR compared to CC [RR (95%CI): 1.18 (1.05-1.32); Ι 2 = 71%]; EAC benefits more endoscopists with ADR ≤ 35% compared to those with ADR > 35% [RR (95%CI): 1.37 (1.08-1.74); Ι 2 = 49% vs 1.10 (0.99-1.24); Ι 2 = 71%]. In terms of AADR and MAC, no difference was detected between EAC and CC [RR (95%CI): 1.03 (0.85-1.25); Ι 2 = 15% and MD (95%CI): 0.30 (-0.17-0.78); Ι 2 = 99%]. Subgroup analysis did not show any difference between the two device generations regarding all three endpoints. In EAC arms, the device had to be removed in 3% (95%CI: 2%-5%) of the cases mainly due to tortuous sigmoid or presence of diverticula along it. CONCLUSION EAC increases ADR compared to CC, especially for endoscopists with lower ADR. On the other hand, no significant effect on AADR and MAC was detected.

Recent advances in colonoscopy

“…This was true for both high-detector colonoscopists and those with lower ADRs, averaging an improvement in adenoma detection across all groups of 7%. These data are encouraging but require tempering from a recent meta-analysis 19 of high-quality studies on the effect of Endocuff-assisted colonoscopy. Although the meta-analysis confirmed the benefit of Endocuff in adenoma detection (particularly amongst low to moderate detectors), the improvement was not as marked as previous studies suggested; the number needed to treat was 19, prompting considerations of cost.…”

Advances in endoscopy for colorectal polyp detection and classification

“…A meta-analysis comparing the Endocuff vs conventional colonoscopy demonstrated an increase in ADR, especially in those endoscopists with an ADR <35%. 22 In a randomized prospective multicenter trial of 500 individuals, ADR was significantly increased with the use of the Endocuff compared to standard colonoscopy (35.4% [95% CI 29% to 41%] vs 20.7% [95%CI 15% to 26%], P < 0.0001). 23 In another randomized prospective trial involving 498 individuals, the polyp detection rate in patients increased by 14% with the use of Endocuff (56% vs 42%, P ¼ 0.001), especially in the sigmoid region.…”

The evolution of lower gastrointestinal endoscopy: where are we now?

“…EndoCuff (Arc Medical Ltd., Leeds, UK), shown in Figure 2 , is a disposable plastic cap that is attached to the endoscope tip with plastic soft branches that extend on withdrawal, holding colonic folds open. Evidence has been mixed, with some meta-analyses showing improved ADR [41.3% versus 34.2%, 23 relative risk (RR) = 1.18, 24 odds ratio = 1.37 25 ]. The prospective randomised controlled trial (RCT; ADENOMA TRIAL) showed an ADR of 40.9% versus 36.2% in the bowel cancer screening programme; 26 however, a prospective RCT in bowel scope patients (B- ADENOMA) showed no improvement compared with conventional endoscopy.…”