Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial

Abstract

ObjectiveLow adenoma detection rates (ADR) are linked to increased postcolonoscopy colorectal cancer rates and reduced cancer survival. Devices to enhance mucosal visualisation such as Endocuff Vision (EV) may improve ADR. This multicentre randomised controlled trial compared ADR between EV-assisted colonoscopy (EAC) and standard colonoscopy (SC).DesignPatients referred because of symptoms, surveillance or following a positive faecal occult blood test (FOBt) as part of the Bowel Cancer Screening Programme were recruited from seven hospitals. ADR, mean adenomas per procedure, size and location of adenomas, sessile serrated polyps, EV removal rate, caecal intubation rate, procedural time, patient experience, effect of EV on workload and adverse events were measured.Results1772 patients (57% male, mean age 62 years) were recruited over 16 months with 45% recruited through screening. EAC increased ADR globally from 36.2% to 40.9% (P=0.02). The increase was driven by a 10.8% increase in FOBt-positive screening patients (50.9% SC vs 61.7% EAC, P<0.001). EV patients had higher detection of mean adenomas per procedure, sessile serrated polyps, left-sided, diminutive, small adenomas and cancers (cancer 4.1% vs 2.3%, P=0.02). EV removal rate was 4.1%. Median intubation was a minute quicker with EAC (P=0.001), with no difference in caecal intubation rate or withdrawal time. EAC was well tolerated but caused a minor increase in discomfort on anal intubation in patients undergoing colonoscopy with no or minimal sedation. There were no significant EV adverse events.ConclusionEV significantly improved ADR in bowel cancer screening patients and should be used to improve colonoscopic detection.Trial registration numberNCT02552017, Results; ISRCTN11821044, Results.

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

“…Six studies were eligible for the analysis of SSA/P detection rate. At least one SSA/P was detected in 15.5% of patients in the EAC group and 13.2% 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 …”

“…The Endocuff, which is a flexible cap with two circle rows of plastic, hinged soft wings, has been developed to improve the ADR compared with SC . It flattens the mucosal folds during withdrawal and keeps the tip of the colonoscope steady during interventions.…”

British Society of Gastroenterology Endoscopy Quality Improvement Programme (BSG EQIP): Implementing new endoscopic techniques and technologies into clinical practice

“…A recent example of this was the BSG supported Accuracy of Detection using Endocuff Optimisation of Mucosal Abnormalities study that delivered a 1700 patient multicentre RCT for an industry cost of approximately £150 000 plus free devices 7. The use of the Endocuff Vision device in this study was shown to significantly improve adenoma detection rates which has implications for a change in conventional practice.…”