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

Abstract

Background and Aim Transparent hood‐assisted colonoscopy (TAC) has been reported to improve the cecal insertion rate and adenoma detection rate (ADR). An endoscopic cap (Endocuff) with two rows of soft wings was recently developed to improve ADR, by flattening the mucosal folds during withdrawal. This randomized prospective control study aimed to compare ADR between Endocuff‐assisted colonoscopy (EAC) and TAC. Methods A total of 513 patients undergoing colon adenoma screening were included. EAC was performed in 256 patients and TAC in 260 patients. Cecal intubation rate, cecal intubation time, ADR, and mean adenoma number per patient (MAP) were investigated in both groups (clinical trial registration: UMIN000016278). Results We excluded six patients in the EAC group and two patients in the TAC group because of colonic stenosis due to colonic adenocarcinomas. Finally, 250 patients (151 men/99 women, median age 62.1 years) were assigned to EAC and 258 patients (165 men/93 women, median age 64.3 years) were assigned to TAC. There were no significant differences in cecal intubation rate, intubation time, withdrawal time, and cleanliness score between groups. The ADR was 50.8% in EAC and 52.7% in TAC, with no significant difference (P = 0.666). The MAP was 1.35 in EAC and 1.20 in TAC, with no significant difference (P = 0.126). However, The MAP of diminutive adenomas (< 5 mm) tended to be higher in EAC than in TAC (P = 0.077). There was no significant difference in MAP in each segment between groups. Conclusions Endocuff‐assisted colonoscopy might be equivalent to TAC in cecal intubation time, ADR, and MAP.

Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection: A Network Meta-analysis

“…All 25 RCTs were 2-arm controlled trials, in which 14 compared Cap-assisted colonoscopy with SC, 21-34 9 compared Endocuff with SC, 35-43 1 compared Endorings with SC, 44 and 1 compared Endocuff with Cap. 45 The PDR was reported in all included trials, the ADR was registered in 20 RCTs, 22,[24][25][26][28][29][30]32,33,[35][36][37][38][39][40][41][42][43][44][45] the cecal intubation rate in 16 RCTs, 22,23,[25][26][27][28][29][30][31][32][33][34]37,40,43,45 and cecal intubation time in 17 RCTs. [21][22][23][24][25][26][28][29][30]32,34,…”

“…21,23,26,27,31,33,34 Quality assessment was performed in the context of the primary outcome, and overall the studies were believed to be at moderate risk of bias, mainly owing to performance and detection bias related to the unblinded design of the included RCTs. Six abstracts 35,36,38,41,42,45 and 5 full-text reports 21,23,27,31,34 were considered at higher risk of bias because of incomplete outcome reporting. Overall and study-level quality assessments are summarized in Supplementary Figure 1A and B, respectively.…”

“…Pairwise meta-analysis. Overall, based on 20 RCTs 22,[24][25][26][28][29][30]32,33,[35][36][37][38][39][40][41][42][43][44][45] (14,293 patients), distal attachment devices showed increased rates of adenoma detection as compared with SC (39.3% vs 35.1%; RR, 1.13; 95% CI, 1.03-1.23; P ¼ .007; I 2 ¼ 75%) ( Supplementary Figure 2). This would translate into a potential absolute increase in ADR to 11.3% and 45.2% Figure 3).…”

“…RCTs [21][22][23][24][25][26][28][29][30]32,34,35,39,41,[43][44][45] enrolling 11,097 patients reported data on the comparison of cecal intubation time between add-on devices and SC. Distal attachment devices lead to significantly shorter cecal intubation times as compared with SC (mean difference, -0.71; -0.33 to -1.09; P < .001), with considerable heterogeneity (I 2 ¼ 89%).…”

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

“…In this issue of JGH, Imaeda et al 4 present an interesting headto-head RCT comparing Endocuff-assisted colonoscopy (EAC) and transparent-hood assisted colonoscopy (TAC). The study was conducted at a single center in Japan with a non-blinded design.…”