Higher Adenoma Detection Rates with Endocuff-Assisted Colonoscopy – A Randomized Controlled Multicenter Trial

Abstract

ObjectivesThe Endocuff is a device mounted on the tip of the colonoscope to help flatten the colonic folds during withdrawal. This study aimed to compare the adenoma detection rates between Endocuff-assisted (EC) colonoscopy and standard colonoscopy (SC).MethodsThis randomized prospective multicenter trial was conducted at four academic endoscopy units in Germany. Participants: 500 patients (235 males, median age 64[IQR 54–73]) for colon adenoma detection purposes were included in the study. All patients were either allocated to EC or SC. The primary outcome measure was the determination of the adenoma detection rates (ADR).ResultsThe ADR significantly increased with the use of the Endocuff compared to standard colonoscopy (35.4%[95% confidence interval{CI} 29–41%] vs. 20.7%[95%CI 15–26%], p<0.0001). Significantly more sessile polyps were detected by EC. Overall procedure time and withdrawal time did not differ. Caecal and ileum intubation rates were similar. No major adverse events occurred in both groups. In multivariate analysis, age (odds ratio [OR] 1.03; 95%[CI] 1.01–1.05), male sex (OR 1.74; 95%CI 1.10–2.73), withdrawal time (OR 1.16; 95%CI 1.05–1.30), procedure time (OR 1.07; 95%CI 1.04–1.10), colon cleanliness (OR 0.60; 95%CI 0.39–0.94) and use of Endocuff (OR 2.09; 95%CI 1.34–3.27) were independent predictors of adenoma detection rates.ConclusionsEC increases the adenoma detection rate by 14.7%(95%CI 6.9–22.5%). EC is safe, effective, easy to handle and might reduce colorectal interval carcinomas.Trial RegistrationClinicalTrials.gov NCT02034929.

Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans

“…These newer devices are simple, disposable, and relatively inexpensive attachments to the standard colonoscope. Both devices report higher ADRs, minimal patient discomfort, low complication rates, high CIRs and no additional procedure time (6,25). Our study was able to reproduce an increase in ADR of 9%, although it did not reach statistical significance.…”

“…Among the many colonoscopy quality measures, adenoma detection rate Many accessories have been created to increase the detection of polyps and improve ADR. Among these the Endocuff overtube (MEDIVATORS) device has shown promise (6).…”

Endoscopic Improvement of the Adenoma Detection Rate during Colonoscopy - Where Do We Stand in 2015?

“…In a recently published Swiss feasibility study with analysis of 104 EC-assisted colonoscopies, a good ADR of 47% was measured [76]. Biecker and Floer published 2 larger randomized controlled trials showing superiority of EndoCuff-assisted colonoscopy in terms of ADR [18,77]. The ADR significantly increased with the use of the EndoCuff compared to standard colonoscopy (35.4 vs. 20.7%, p < 0.0001).…”

“…One advantage of the EndoCuff compared to EndoRings might be the fact that the intubation of the terminal ileum can easily be performed. In all prospective studies available for EndoCuff, the rate of ileum intubation did not differ statistically compared to standard colonoscopy [18,77]. Thus, colonoscopy with EndoRings is therefore limited to the colon.…”

Advances in endoscopic diagnosis of colorectal cancer

“…Endocuff has two rings of soft, flexible branches that are used to flatten the colonic folds while withdrawing the scope, making the area behing folds more visible. Its efficacy was evaluated in various studies, showing similar or higher adenoma detection rate (ADR) compared to standard colonoscopy [20,21].…”