Endocuff vision-assisted vs. standard polyp resection in the colorectum (the EVASTA study): a prospective randomized study

Abstract

Background Cap-assisted colonoscopy is frequently used to facilitate adenoma detection during endoscopy. However, data on how cap assistance influences polyp resection are scarce. We aimed to evaluate the impact of cap assistance with the Endocuff vision device (EVD) on the resection time for colorectal polyps in patients undergoing colonoscopy. Methods A randomized, prospective study was performed in a university hospital in Germany. A total of 250 patients were randomly assigned 1:1 to undergo either colonoscopy with the EVD (EVD arm) or standard colonoscopy without the use of a cap (standard arm). The primary outcome was the average duration of polypectomy. Secondary outcomes included adenoma detection rate, cecal and ileal intubation times, and propofol dosage. Results The use of EVD led to a significant reduction in the median polypectomy time in the EVD vs. standard arm (54 vs. 80 seconds, respectively; P = 0.02). This effect was strongest for polyps ≥ 6 mm. Compared with the standard group, Endocuff assistance also resulted in a shorter cecal intubation time (6 vs. 8 minutes; P = 0.03) and overall colonoscopy time (23 vs. 27 minutes; P = 0.02). In contrast, no difference in withdrawal time was observed. The polyp and adenoma detection rates did not differ significantly between the two groups. Conclusion Endocuff-assisted colonoscopy reduces the duration of polypectomy, which may be due to a more stable scope position during resection. Further studies are needed to investigate whether comparable effects will be seen for other interventions, such as clipping or biopsy sampling.

Efficacy of Endocuff Vision compared to first-generation Endocuff in adenoma detection rate and polyp detection rate in high-definition colonoscopy: a systematic review and network meta-analysis

“…Twelve RCTS were included after rigorous screening of abstracts and full texts with a total of 8638 patients (4285 in HD group, 4353 in Endocuff group) (▶ Fig. 1) [15,[25][26][27][28][29][30][31][32][33][34][35]. All studies were published after 2014.…”

“…A statistically and clinically significant improvement in PDR was noted for ECV colonoscopy compared to HD colonoscopy (52.5 % vs 45.5 %, RR: 1.15, 95 % CI 1.03-1.28, P = 0.01, I 2 = 67.0 %) (▶ Fig. 2c) [15,25,29,33]. Similarly, PDR was found to be improved for ECU colonoscopy compared to HD statistically and clinically (65.6 % vs 52.9 %, RR: 1.26, 95 % CI 1.09-1.46, P = 0.002, I 2 = 74.9 %) (▶ Fig.…”

“…A total of six studies assessed ADR and a statistically insignificant but improved detection trend was observed for ECV compared to HD colonoscopy (42.6 % vs 36.8 %, RR: 1.12, 95 % CI 0.99-1.27, P = 0.07, I 2 = 66.6 %) (▶ Fig. 2a) [15,25,29,30,33]. Six studies compared ECU to HD colonoscopy and improved ADR was observed for ECU colonoscopy that was statistically significant (48.3 % vs 41.1 %, RR: 1.22, 95 % CI 1.05-1.43, p = 0.01, I 2 = 71.4 %) (▶ Fig.…”

“…The groups were similar in terms of age range (55.7-68 vs 55.1-68), male gender (52.9 % vs 52.1 %) and screening/surveillance indication (60.8 % vs 60.7 %). Of the Endocuff group, 2627 patients (6 studies) underwent ECV colonoscopy [14,25,29,30,33,35] and 1726 patients (6 studies) underwent ECU colonoscopy [26-28, 31, 32, 34] (▶ Table 1). The outcomes for individual studies are summarized in ▶ Table 2.…”

A “vision” for fast snaring: please take your time

“…At this point, we must congratulate Dr. Guido von Figura and his colleagues for taking a step forward to explore the utility of this add-on device by conducting an elegantly designed prospective, randomized study to examine whether use of the EVD can accelerate the resection of colonic polyps [4]. The authors randomized 250 patients to undergo either EVD-assisted or standard colonoscopy, which was performed by 14 endoscopists inexperienced in use of the EVD.…”