Second-generation distal attachment cuff improves adenoma detection rate: meta-analysis of randomized controlled trials

Patel, Harsh K.; Chandrasekar, Viveksandeep Thoguluva; Srinivasan, Sachin; Patel, Suchi K.; Dasari, Chandra S.; Singh, Manu Pratap; Cam, Elise Le; Spadaccini, Marco; Rex, Douglas K.

doi:10.1016/j.gie.2020.09.045

Cited by 38 publications

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“…Among these, the Endocuff device has shown the ability to improve the ADR. 5,6 Cap-assisted colonoscopy has shown benefit for the visualisation of polyps in the right colon flexure and the ascending colon. 7 However, results concerning the ADR remain inconclusive.…”

Section: Introductionmentioning

confidence: 99%

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Standard versus Endocuff versus cap‐assisted colonoscopy for adenoma detection: A randomised controlled clinical trial

et al. 2021

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Background and aims Adenoma detection rate (ADR) in colon cancer screening is most important for cancer prophylaxis. This work is the first three-armed randomised controlled clinical trial aimed at comparing a head-to-head setting standard colonoscopy (SC) with Endocuff-assisted colonoscopy (EC) and cap-assisted colonoscopy (CAC) for improvement of ADR. Methods Patients from Poland and Germany with independent indication for colonoscopy were randomised into three arms of this trial: EC, CAC and SC. Exclusion criteria were age <18 years, active Crohn’s disease or ulcerative colitis, known stenosis and post-colonic resection status. Results A total of 585 patients (195 SC, 189 EC and 186 CAC) were enrolled in this study. Indications were not different between the groups (colorectal cancer screening 51%, diagnostic colonoscopy in 31% and post polypectomy follow-up in 18%; p=0.94). Withdrawal time was a mean of seven minutes in all groups ( p=0.658), and bowel preparation did not differ between the groups. The time to reach the caecum was significantly reduced when using the cap (a mean of six minutes for CAC vs. seven minutes for SC; p=0.0001). There was no significant difference in the primary outcome of the ADR between the groups (EC 32%, CAC 30%, SC 30%; p=0.815). EC proved to be superior (EC vs. SC) in the sigmoid colon and transverse colon for polyp detection. Conclusion The use of EC increased the total number of polyps seen during colonoscopy. In contrast to recent studies, no significant improvement of the ADR was detected.

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Section: Introductionmentioning

confidence: 99%

“…Therefore, improving the ADR is important for successful colon cancer prevention. Among these, the Endocuff device has shown the ability to improve the ADR 5,6 . Cap‐assisted colonoscopy has shown benefit for the visualisation of polyps in the right colon flexure and the ascending colon 7 .…”

Section: Introductionmentioning

confidence: 99%

Standard versus Endocuff versus cap‐assisted colonoscopy for adenoma detection: A randomised controlled clinical trial

et al. 2021

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“…The meta-analysis argues that CAC improves ADR compared with standard highdefinition colonoscopy alone, especially in the screening and surveillance population. 4 Our own experience with both firstand secondgeneration CACs has been a positive one overall. The flexible arms live up to the hype of flattening folds, exposing more colonic surface area.…”

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confidence: 87%

“…The third factor is that some studies included patients with a positive result for the FOBT; this may inherently yield higher ADRs from which it is harder to detect improvements with CAC. Patel et al 4 investigated this theory in an analysis looking at studies that involved only screening and surveillance colonoscopies but excluded patients with a positive result for the FOBT. They found an increased risk ratio of 1.21 and increased homogeneity of results (I 2 Z 3%) once those with a positive result for the FOBT were excluded from the metanalysis (P Z .0004), supporting the idea that the FOBT population may be a confounder when investigating the efficacy of CAC.…”

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confidence: 99%

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Cuff-assisted colonoscopy: Should you be riding the mechanical enhancement wave?

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2021

Gastrointestinal Endoscopy

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Detection of colorectal lesions during colonoscopy

2021

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Owing to its high mortality rate, the prevention of colorectal cancer is of particular importance. The resection of colorectal polyps is reported to drastically reduce colorectal cancer mortality, and examination by endoscopists who had a high adenoma detection rate was found to lower the risk of colorectal cancer, highlighting the importance of identifying lesions. Various devices, imaging techniques, and diagnostic tools aimed at reducing the rate of missed lesions have therefore been developed to improve detection. The distal attachments and devices for improving the endoscopic view angle are intended to help avoid missing blind spots such as folds and flexures in the colon, whereas the imaging techniques represented by image‐enhanced endoscopy contribute to improving lesion visibility. Recent advances in artificial intelligence‐supported detection systems are expected to supplement an endoscopist's eye through the instant diagnosis of the lesions displayed on the monitor. In this review, we provide an outline of each tool and assess its impact on the reduction in the incidence of missed colorectal polyps by summarizing previous clinical research and meta‐analyses. Although useful, the many devices, image‐enhanced endoscopy, and artificial intelligence tools exhibited various limitations. Integrating these tools can improve their shortcomings. Combining artificial intelligence‐based diagnoses with wide‐angle image‐enhanced endoscopy may be particularly useful. Thus, we hope that such tools will be available in the near future.

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Second-generation distal attachment cuff improves adenoma detection rate: meta-analysis of randomized controlled trials

Cited by 38 publications

References 24 publications

Standard versus Endocuff versus cap‐assisted colonoscopy for adenoma detection: A randomised controlled clinical trial

Standard versus Endocuff versus cap‐assisted colonoscopy for adenoma detection: A randomised controlled clinical trial

Cuff-assisted colonoscopy: Should you be riding the mechanical enhancement wave?

Detection of colorectal lesions during colonoscopy

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