Endocuff-assisted versus Cap-assisted Colonoscopy in Increasing Adenoma Detection Rate. A Meta-analysis

Abstract

Background and Aims: Several add-on devices have been developed to increase rates of colon adenoma detection. We aimed to compare the endocuff-assisted colonoscopy with cap-assisted colonoscopy through a pairwise meta-analysis of randomized trials.
 Methods: We searched the PubMed/Medline and Embase database through March 2020 and identified 6 randomized controlled trials (comprising 2,027 patients). The primary outcome was adenoma detection rate; secondary outcomes included sessile serrated adenoma detection rate, mean adenoma per colonoscopy, cecal intubation rate and time to reach cecum. Safety data were also analyzed. We performed pairwise meta-analysis through a random effects model and expressed data as risk ratio and 95% confidence interval.
 Results: Overall, pooled adenoma detection rate was 48.1% (39.3-56.8%) with endocuff and 40.5% (30.4- 50.6%; risk ratio 1.14, 0.96-1.35) with cap. Proximal adenoma detection rate was 45.7% (36.8-54.7%) and 24% (17-45.1%) with endocuff and cap, respectively (risk ratio 2.04, 0.93-4.49), whereas endocuff outperformed cap-assisted colonoscopy in detecting diminutive (≤ 5 mm) adenomas (risk ratio 2.74, 1.53-4.90) and in terms of mean adenoma per colonoscopy (mean difference 0.31, 0.05 -0.57; p=0.02). Sessile serrated adenoma detection rate (risk ratio 1.36, 0.72-2.59), cecal intubation rate (risk ratio 0.99, 0.98-1.00), and time to reach cecum (6.87 min versus 6.87 min) were similar between the two groups. No serious adverse event was observed.
 Conclusion: Endocuff-assisted colonoscopy seems to provide a higher adenoma detection rate as compared to cap-assisted colonoscopy, in particular concerning smaller diminutive polyps.

Efficacy of Combination Colonoscopy Using Modified Cap-assisted and Water-exchange Colonoscopy with Prone Position in the Detection of Colorectal Adenomas: A Retrospective Study

“…In this study, the ADR in the CWP group (70.1%) as well as in the CC group (49.2%) were higher than that of previous studies with 40.5% in cap-assisted colonoscopies (meta-analysis) [27], 41.7% in water exchange colonoscopies (network meta-analysis) [13], and 44% in cap-assisted water immersions (singlecenter trial) [28]. The high ADR in both groups could be associated with the high quality colonoscopy with long withdrawal time.…”

Impact of EndoRings on colon adenoma detection rate: A meta‐analysis of randomized trials

“…A recent network meta‐analysis published by our group demonstrated the highest improvement in ADRs with use of Endocuff (Endocuff®, Arc Medical Design, Leeds, UK), although without clear benefit over the other commonly used add‐on device, namely, Cap (Olympus Medical Systems, Tokyo, Japan). This finding has been recently confirmed in two pairwise meta‐analyses of randomized controlled trials (RCTs) directly comparing the two devices 14,15 …”

“…However, one of the main limitations of the aforementioned systematic reviews 11–15 was the very limited evidence available concerning the use of EndoRings® (EndoAid Ltd, Caesarea, Israel), which prevented a valid assessment of the impact of this newer device in the endoscopic practice. In a previous four‐arm RCT, directly comparing EndoRings with Endocuff, full‐spectrum endoscopy (FUSE), and standard colonoscopy, EndoRings seemed to have even more of a tendency than Endocuff to straighten the lumen and flatten the haustral folds in the left side of the colon, although its mucosal gripping properties seemed to cause it to jump back twofold or threefold at times during withdrawal through the sigmoid 16 …”

Editorial: Cuff‐ and cap‐assisted colonoscopy: More questions than answers

“…Two recent meta-analyses included six RCTs and found no difference in ADR, withdrawal time or cecal intubation rate, but EAC detected more diminutive polyps. 9,10 Another study compared all available attachable devices in a network meta-analysis of 25 RCTs. Only a modest increase in ADR was found with EAC (relative risk [RR] 1.13; 95% CI, 1.03-1.23), in particular in low-performing endoscopists.…”

“…In addition, different RCTs did not find a difference when using EAC or CAC and showed even, in part, conflicting results. Two recent meta‐analyses included six RCTs and found no difference in ADR, withdrawal time or cecal intubation rate, but EAC detected more diminutive polyps 9,10 . Another study compared all available attachable devices in a network meta‐analysis of 25 RCTs.…”