Endocuff Improves Polyp Detection by GI Fellows Across Multiple Stages of Training

Abstract

Introduction: The Endocuff (EC) is a cap with soft, finger-like projections designed to flatten colonic folds during withdrawal to improve polyp detection. We previously showed that use of Endocuff in GI fellow-performed procedures is assoc with higher polyp detection rate (PDR) and number of polyps per procedure (PPP). This study was designed to assess how level of training affects these variables. Methods: Colonoscopy quality data was collected prospectively at our center beginning in June 2012. EC was implemented in Aug 2014 and utilized at the discretion of the colonoscopists. For this study, the dataset included all colonoscopies performed by GI fellows since initiation of database, inclusive of all indications. A total of 2465 colonoscopies, including 1841 conventional (CC) and 624 Endocuff-assisted colonoscopies (EC), were included. Procedures were grouped by performing fellow's level of training at that time, i.e. 0-12 mo. (1st yr), 13-24 mo. (2nd yr), or 25-36 mo. (3rd yr). CC and EC in each group were compared with respect to procedure times, PDR, ADR, PPP and APP. All polyps were removed by forceps, snare or EMR. Significance was determined by two-tailed T-test. Results: Compared to CC, EC was assoc with a higher PDR among 1st (0.78 vs. 0.64, p=0.003) and 2nd yr fellows (0.87 vs. 0.67, p < 0.0005). Benefit of EC was marginal among 3rd yr fellows (0.82 vs. 0.71, p=0.06). ADR was highest in 2nd yr fellows (0.62 vs. 0.43, p < 0.0005), but did not reach statistical significance for the 1st and 3rd yr fellows (see table). Similarly, PPP and APP, respectively, were significantly higher among 1st (2.87 vs. 1.77, p=0.003; 1.35 vs. 0.92, p=0.004) and 2nd yr fellows (3.43 vs. 2.13, p=0.0005, 1.69 vs. 1.15, p=0.007). Insertion time was significantly reduced with EC in 1st and 2nd yr fellows (16.6 vs. 19.6min, p=0.03, 11.8 vs. 16.7min, p=0.02). Despite the increased number of polyps in EC cases, withdrawal and total times were not increased. Conclusion: Among our fellows, use of EC increased the detection rate and numbers of polyps and adenomas found and removed, especially in the first 2 years of training. This benefit occurs without affecting total time of procedure. Our findings suggest that use of EC by fellows increases polypectomies, which should improve patient outcomes by reducing risk of interval colorectal cancer. While our study was not randomized and is therefore subject to bias, our findings encourage expanded use of assistive devices such as Endocuff by GI fellows.Table 1: Results, by Training Year