Endocuff-assisted vs. standard colonoscopy in the fecal occult blood test-based UK Bowel Cancer Screening Programme (E-cap study): a randomized trial

Abstract

Up to 25 % colorectal adenomas are missed during colonoscopy. The aim of this study was to investigate whether the endocuff could improve polyp detection in an organized bowel cancer screening program (BCSP). This parallel group, single-blinded, randomized controlled trial included patients with positive fecal occult blood test (FOBT) who were attending for BCSP colonoscopy. The primary outcome was the number of polyps per patient. Secondary outcomes included the number of adenomas per patient, adenoma and polyp detection rates, and withdrawal times. A total of 534 BCSP patients were randomized to endocuff-assisted or standard colonoscopy. The mean age was 67 years and the male to female ratio was 1.8:1. We detected no significant difference in the number of polyps per patient (standard 1.8, endocuff 1.6; = 0.44), adenomas per patient (standard 1.4, endocuff 1.3; = 0.54), polyp detection rate (standard 69.8 %, endocuff 70.3 %; = 0.93), adenoma detection rate (standard 63.0 %, endocuff 60.9 %; = 0.85), advanced adenoma detection rate (standard 18.5 %, endocuff 16.9 %; = 0.81), and cancer detection rate (standard 5.7 %, endocuff 5.3 %; = 0.85). The mean withdrawal time was significantly shorter among patients in the endocuff group compared with the standard colonoscopy group (16.9 vs. 19.5 minutes; < 0.005). The endocuff had to be removed in 17/266 patients (6.4 %) because of inability to pass through the sigmoid colon. This study did not find improved polyp or adenoma detection with endocuff-assisted colonoscopy in the FOBT-positive BCSP population. A shorter withdrawal time with endocuff may reflect improved views and stability provided by the endocuff.Trial registered at ClinicalTrials.gov (NCT02529007).

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

“…Eight studies evaluated adverse events between two groups. Adverse events occurred in 2.6% of patients in the EAC group and 0.8% in the SC group.…”

“…Four studies reported advanced adenoma detection rate. At least one advanced adenoma was detected in 14.7% of patients in the EAC group and 15.2% in the SC group.…”

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

“…High‐definition colonoscopes aid in detection and are now widely considered fundamental to detection and effective treatments . Adjunctive devices and techniques have also been widely investigated, including chromoendoscopy and image‐enhanced endoscopy; mucosal exposure devices such as transparent hood, Endocuff, EndoRings,and the Third Eye Retroscope; and ultra‐wide‐angle endoscopes such as full‐spectrum endoscopy and the extra‐wide‐view colonoscope …”

“…6 High-definition colonoscopes aid in detection and are now widely considered fundamental to detection and effective treatments. 7 Adjunctive devices and techniques have also been widely investigated, including chromoendoscopy [8][9][10] and image-enhanced endoscopy [11][12][13] ; mucosal exposure devices such as transparent hood, [12][13][14][15][16][17][18] Endocuff, [19][20][21][22][23][24][25][26][27][28][29][30][31] EndoRings, 6,32 and the Third Eye Retroscope 33 ; and ultra-wide-angle endoscopes such as full-spectrum endoscopy 6,34 and the extra-wide-view colonoscope. 35,36 A transparent hood attached to the distal tip of the colonoscope has been reported to improve the cecal intubation rate and adenoma detection rate (ADR) compared with standard colonoscopy (SC).…”

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

“…Endocuff‐assisted colonoscopy (EAC) has been investigated extensively with many studies showing improved adenoma detection compared with standard colonoscopy. However, larger multicenter randomized controlled trials (RCT) have not shown a consistent benefit for enhanced adenoma detection and a further study has shown ADR to be numerically worse with EAC . Faccioruso et al .…”