Endocuff-assisted Colonoscopy Research Articles

The impact of EndoCuff-assisted colonoscopy on the polyp detection rate: A cross-over randomized back-to-back study

Background and study aimsColorectal cancer (CRC) is one of the most common cancers worldwide, and most CRCs develop from polyps with malignant potential. We aimed to study the difference in polyp detection rate between EndoCuff-assisted colonoscopies (EAC) and standard colonoscopy (SC). Patients and methodsThis study was conducted at Cairo University Hospitals on patients referred for screening or diagnostic colonoscopy from July 2018 to August 2020. All included patients underwent back-to-back standard colonoscopy (SC) and ENDOCUFF VISION-assisted colonoscopies (EAC). Results214 patients were included in this study. In comparison between EAC and SC, EAC increased the polyp detection rate (69 (32.24 %) vs. 57(26.64 %) (p < 0.05), EAC increased the detection of diminutive polyps ≤ 5 mm (104 vs. 81) (p < 0.05), and small polyps 6–9 mm (12 vs. 10) while there was no difference in large polyps ≥ 10 mm. EAC increased the adenoma detection rate (ADR) (37 (17.2 %) vs. 32(14.9 %) (p < 0.05). The findings detected by EAC shortened the interval of surveillance determined by SC findings. EndoCuff caused six mucosal erosions (2.8 %) in patients. ConclusionEAC increases the number of detected colonic polyps, primarily small polyps on the left and right sides of the colon.

S342 Utilization of Endocuff-Assisted Colonoscopy and Computer-Aided Detection in Optimizing Colonoscopies in the Elderly

S342 Utilization of Endocuff-Assisted Colonoscopy and Computer-Aided Detection in Optimizing Colonoscopies in the Elderly

Combination of Mucosa-Exposure Device and Computer-Aided Detection for Adenoma Detection During Colonoscopy: A Randomized Trial

Both Computer-aided detection (CADe)- assisted and Endocuff-assisted colonoscopy have shown to increase adenoma detection. We investigated the performance of the combination of the two tools compared to CADe-assisted colonoscopy alone to detect colorectal neoplasias during colonoscopy in a multicenter randomized trial. Men and women undergoing colonoscopy for CRC screening, polyp surveillance, or clincial indications at 6 centers in Italy and Switzerland were enrolled. Patients were assigned (1:1) to colonoscopy with the combinations of CADe (GI-Genius, Medtronic) and a mucosal exposure device (Endocuff Vision -ECV-, Olympus) or to CADe-assisted colonoscopy alone (control group). All detected lesions were removed and sent to histopathology for diagnosis. The primary outcome was adenoma detection rate (ADR, the percentage of patients with at least 1 histologically proven adenoma or carcinoma). Secondary outcomes were adenomas detected per colonoscopy, advanced adenomas and serrated lesions detection rate, the rate of unnecessary polypectomies (polyp resection without histologically proven adenomas), and withdrawal time. From July 1, 2021 to May 31, 2022, 1316 subjects were randomized and eligible for analysis; 660 to the ECV group, 656 to control group). The ADR was significantly higher in the ECV group (49.6%) than in the control group (44.0%) (relative risk [RR], 1.12; 95% confidence interval [CI], 1.00-1.26; p = 0.04). Adenomas detected per colonoscopy were significantly higher in the ECV group (mean, 0.94+0.54) than in the control group (0.74+0.21) (incidence rate ratio, 1.26; 95% CI: 1.04-1.54; p: 0.02). The two groups did not differ in term of detection of advanced adenomas and serrated lesions. There was no significant difference between groups in withdrawal time (9.01±2.48 seconds for the ECV group vs 8.96 ±2.24 for controls; P = 0.69) or proportion of subjects undergoing unnecessary polypectomies (RR: 0.89; 95% CI: 0.69-1.14. p: 0.38). The combination of CADe and EndocuffVision during colonoscopy increases ADR and adenomas detected per colonoscopy without increasing withdrawal time compared to CADe alone. gov no: NCT04676308.

Computer-aided detection, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: a randomized controlled trial

Computer-aided detection (CADe) and a mucosal exposure device can improve adenoma detection rate (ADR). Potential benefits of combining the 2 modalities have never been studied. This study aimed to compare ADR differences among CADe alone, endocuff-assisted colonoscopy (EAC) alone, and the combination of CADe and EAC (CADe+EAC) with standard colonoscopy. This prospective randomized controlled study included 1245 participants who underwent screening colonoscopy. Participants were randomized to CADe, EAC, CADe+EAC, and standard colonoscopy as a control. The primary outcome was ADR. Secondary outcomes were proximal ADR (pADR), advanced ADR (AADR), and the number of adenomas per colonoscopy (APCs). ADRs from the control, CADe, EAC, and CADe+EAC groups were 41.9%, 52.2%, 54.0%, and 58.8%, respectively; pADRs were 25.2%, 33.3%, 34.9%, and 37.0%, respectively; AADRs were 7.7%, 8.3%, 8.3%, and 13.6%, respectively; and APCs were .76, 1.11, 1.18, and 1.31, respectively. Significant increases in ADR and pADR were observed between the intervention and control groups (P< .05 in all comparisons). The AADR was significantly higher only in the CADe+EAC group than in the control group (P= .02). The adjusted incidence rate ratios of APCs were significantly higher in the intervention groups versus the control group (P< .01 in all comparisons). CADe+EAC significantly improve ADR and AADR over standard colonoscopy. However, although CADe or EAC alone can substantially increase the detection of adenomas, they do not lead to increased detection of advanced adenomas unless used in combination. (Clinical trial registration number: TCTR20200929003.).

S312 Comparing the Adenoma Detection Rate of Endocuff-Assisted Colonoscopy (EAC) Against Combined Artificial Intelligence and Endocuff-Assisted Colonoscopy (AEAC)

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the world. While effective at preventing CRC, standard colonoscopy can miss precancerous polyps placing patients at risk for interval CRC. Endoscopic mechanical attachments and artificial intelligence (AI) are technologies that have independently shown improvement in adenoma detection rate (ADR). We sought to compare the performance of Endocuff-assisted colonoscopy (EAC) to combined AI and EAC (AEAC) in relation to ADR. Methods: This was a single-center study involving patients who underwent either AEAC or EAC between December 2021 and May 2022. Demographic (age, sex) and clinical (indication, Boston Bowel preparation scale (BBPS), withdrawal time, polyp location, histology and size) data on patients was obtained from the electronic health record. The primary outcome was ADR. Secondary outcomes were polyp detection rate (PDR), adenomas per colonoscopy (APC), polyps per colonoscopy (PPC), sessile serrated lesion rate (SSR) and sessile serrated lesions per colonoscopy (SSPC). Categorical variables were analyzed using a two-sided chi square test. Continuous variables were assessed using the student’s t-test or Mann-Whitney U-test. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression. Results: 148 patients (50.7% men, mean age 60.9 years; 74 AEAC vs 74 EAC) were included. The AEAC group did not differ by age, sex, indication or BBPS from the EAC group (Table). ADR in the AEAC group was higher (71.6% vs 60.8%; OR 1.63; 95% CI 0.82-3.24; P = 0.17). SSR was 14.9% in the EAC group versus 24.3% in the AEAC group (P > 0.05) (Table). For adenomas >5-10mm in size, the AEAC group had a significantly higher ADR (28.4% vs 14.9%; OR 2.27; 95% CI 1.00-5.13; P = 0.05). Withdrawal time was longer in the AEAC group (8.0min vs 7.3min; P = 0.03). Subgroup analysis by indication revealed that ADR trended towards significance for patients in the AEAC group undergoing colonoscopy for CRC screening (70.3% vs 52.3%; OR 2.17; 95% CI 0.94-4.98; P = 0.068). Conclusion: Combining AI with Endocuff-assisted colonoscopy increased ADR, PDR, APC, PPC, SSR and SSPC when compared to EAC. ADR trended towards significance for patients in the AEAC group undergoing CRC screening. This study highlights the potential benefits of maximizing surface area exposure (mechanical enhancement) combined with enhanced mucosal inspection (AI). Future larger studies will be needed to further validate this combination. Table 1. - Patient Demographics and Per-Patient Lesion Analysis Caption Variable EAC (n=74) AEAC (n=74) P Mean age (SD), y 60.8 (9.7) 61.0 (9.9) 0.91 Sex, n (%) 0.87 Male 38 (51.4) 37 (50) Female 36 (48.6) 37 (50) Indication for colonoscopy, n (%) 0.08 Screening 44 (59.5) 54 (73) Surveillance 30 (40.5) 20 (27) Mean BBPS (SD) 8.6 (0.8) 8.5 (0.9) 0.55 Median withdrawal time (IQR), min* 7.3 (6.6-8.2) 8.0 (7.3-8.7) 0.03 Patients with >1 adenoma (ADR), n (%) 45 (60.8) 53 (71.6) 0.17 Adenomas per colonoscopy (APC), (range) 1.43 (0-12) 1.45 (0-5) 0.96 Patients with >1 polyp (PDR), n (%) 66 (89.2) 70 (94.6) 0.23 Polyps per colonoscopy (PPC), (range) 2.55 (0-13) 2.62 (0-16) 0.85 Patients with >1 sessile serrated lesion (SSR), n (%) 11 (14.9) 18 (24.3) 0.15 Sessile serrated lesions per colonoscopy (SSPC), (range) 0.23 (0-4) 0.27 (0-2) 0.67 Adenoma location, n (%)** Right colon 31 (41.9) 33 (44.6) 0.74 Transverse colon 16 (21.6) 17 (23) 0.84 Left colon 22 (29.7) 26 (35.1) 0.48 Adenoma size, n (%)** 1-5mm 40 (54.1) 39 (52.7) 0.87 >5-10mm 11 (14.9) 21 (28.4) 0.05 >10mm 8 (10.8) 11 (14.9) 0.46 Polyp location, n (%)** Right colon 34 (45.9) 42 (56.8) 0.19 Transverse colon 22 (29.7) 22 (29.7) 1.00 Left colon 49 (66.2) 51 (68.9) 0.73 Polyp size, n (%)** 1-5mm 62 (83.8) 55 (74.3) 0.16 >5-10mm 15 (20.3) 24 (32.4) 0.09 >10mm 8 (10.8) 12 (16.2) 0.34 Sessile serrated lesion location, n (%)** Right colon 3 (4.1) 10 (13.5) 0.08 Transverse colon 7 (9.5) 3 (4.1) 0.33 Left colon 5 (6.8) 6 (8.1) 1.00 Sessile serrated lesions size, n (%)** 1-5mm 5 (6.8) 5 (6.8) 1.00 >5-10mm 3 (4.1) 8 (10.8) 0.21 >10mm 4 (5.4) 6 (8.1) 0.75 EAC, Endocuff-assisted colonoscopy; AEAC, artificial intelligence and EAC; SD, standard deviation; BBPS, Boston Bowel Preparation scale; IQR, interquartile range; PDR, polyp detection rate; PPC, polyps per colonoscopy; ADR, adenoma detection rate; APC, adenomas per colonoscopy; SSR, sessile serrated lesion rate; SSPC, sessile serrated lesions per colonoscopy.*There was 1 case missing data in the EAC cohort.**Number of patients with >1 adenoma/polyp/sessile serrated lesion.

S233 Prospective Randomized Trial Comparing Endocuff-Assisted Colonoscopy vs G-EYE Balloon-Assisted Colonoscopy: A Multicenter Study

S233 Prospective Randomized Trial Comparing Endocuff-Assisted Colonoscopy vs G-EYE Balloon-Assisted Colonoscopy: A Multicenter Study

Linked color imaging, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: a randomized trial

By different mechanisms, image-enhancement techniques (linked color imaging [LCI]) and mucosal exposure devices (Endocuff-assisted colonoscopy [EAC]) can improve the adenoma detection rate (ADR) during screening colonoscopy. The impact of the combination of the 2 techniques has never been studied. This study aimed to compare the ADR between the combination of LCI and EAC (LCI+EAC), LCI alone, EAC alone, and standard high-definition (HD) colonoscopy. This prospective randomized controlled trial included participants who underwent screening colonoscopy. Participants were randomized to LCI+EAC, LCI, EAC, and standard HD colonoscopy. All colonoscopies were performed by endoscopists with a recorded ADR≥35%. The primary outcome was the ADR. Secondary outcomes were proximal ADR (pADR) and the mean number of adenomas per colonoscopy (APC). One thousand participants were included in the study. The LCI+EAC group provided the highest ADR and pADR. The ADRs in the LCI+EAC, LCI, EAC, and standard HD colonoscopy groups were 57.2%, 52.8%, 51.6%, and 47.6%, respectively, with pADRs of 38.4%, 34.8%, 33.6%, and 28.0%, respectively. The mean numbers of APC were 1.28, 1.20, 1.16, and .89, respectively. After a multiple comparison adjustment, a significant difference in pADR was only observed between the LCI+EAC and standard HD colonoscopy groups (difference, 10.3 percentage points; 95% confidence interval, .02%-17.4%; P= .05). The incidence rate ratios of the adenoma numbers were significantly higher in the LCI+EAC (1.43), LCI (1.34), and EAC (1.30) groups relative to the standard HD colonoscopy group (.89) (P< .009 for all comparisons). The combination of LCI and EAC can significantly improve the detection of pADR and APC but not ADR by high-ADR performers. (Clinical trial registration number: TCTR20190319001.).

Adenoma detection by Endocuff-assisted versus standard colonoscopy in an organized screening program: the “ItaVision” randomized controlled trial

The Endocuff Vision device (Arc Medical Design Ltd., Leeds, UK) has been shown to increase mucosal exposure, and consequently adenoma detection rate (ADR), during colonoscopy. This nationwide multicenter study assessed possible benefits and harms of using Endocuff Vision in a fecal immunochemical test (FIT)-based screening program. Patients undergoing colonoscopy after a FIT-positive test were randomized 1:1 to undergo Endocuff-assisted colonoscopy or standard colonoscopy, stratified by sex, age, and screening history. Primary outcome was ADR. Secondary outcomes were ADR stratified by endoscopists' ADR, advanced ADR (AADR), adenomas per colonoscopy (APC), withdrawal time, and adverse events. 1866 patients were enrolled across 13 centers. After exclusions, 1813 (mean age 60.1 years; male 53.8 %) were randomized (908 Endocuff Vision, 905 standard colonoscopy). ADR was significantly higher in the Endocuff Vision arm (47.8 % vs. 40.8 %; relative risk [RR] 1.17, 95 % confidence interval [CI] 1.06-1.30), with no differences between arms regarding size or morphology. When stratifying for endoscopists' ADR, only low detectors (ADR < 33.3 %) showed a statistically significant ADR increase (Endocuff Vision 41.1 % [95 %CI 35.7-46.7] vs. standard colonoscopy 26.0 % [95 %CI 21.3-31.4]). AADR (24.8 % vs. 20.5 %, RR 1.21, 95 %CI 1.02-1.43) and APC (0.94 vs. 0.77; P = 0.001) were higher in the Endocuff Vision arm. Withdrawal time and adverse events were similar between arms. Endocuff Vision increased ADR in a FIT-based screening program by improving examination of the whole colonic mucosa. Utility was highest among endoscopists with a low ADR.

EndoCuff-Assisted Colonoscopy Versus Standard Colonoscopy in Colonic Polyp Detection-Experience from a Single Tertiary Centre.

Background. Standard colonoscopy fails to visualize the entire colon mucosa and consequently a significant amount of polyps are still being missed. New device, such as EndoCuff, have been developed to improve mucosal visualisation, hence the quality in colonoscopy. The aim of this study was to assess the diagnostic yield of EndoCuff-assisted colonoscopy in comparison with standard colonoscopy by taking into consideration several quality indicators. Methods. In this study, 965 adults ≥ 18 years referred for colonoscopy were randomly divided into two groups. The main statistical investigation compared the difference between EndoCuff-assisted colonoscopy (EC) vs. standard colonoscopy (SC) in the detection of colonic polyps and adenoma detection rate (ADR). The second inquiry sought to compare experienced vs. recently trained and female vs. male operators. Results. The ADR was higher for EC than for SC (37.50% vs. 26.64%). Regarding the mean number of detected polyps per procedure (MPP), the result was statistically significant when generally comparing the EC vs. SC (p=0.0009). There were no differences in MPP between EC and SC for recently trained endoscopists (p=0.7446), while a significant difference for experienced doctors (p=0,0020) was noted. A significant difference was observed between female doctors and male doctors only when using SC. EC was more helpful for female doctors when assessing MPP (p=0.0118). No serious adverse events related to EndoCuff-assisted colonoscopy was noted. Conclusions. EndoCuff-assisted colonoscopy seems to be safe and may bring benefits for improving the polyp/adenoma detection rates in regard to missed lesions, usually located in blind areas.

Endocuff-assisted versus Cap-assisted Colonoscopy in Increasing Adenoma Detection Rate. A Meta-analysis.

Several add-on devices have been developed to increase rates of colon adenoma detection. We aimed to compare the endocuff-assisted colonoscopy with cap-assisted colonoscopy through a pairwise meta-analysis of randomized trials. We searched the PubMed/Medline and Embase database through March 2020 and identified 6 randomized controlled trials (comprising 2,027 patients). The primary outcome was adenoma detection rate; secondary outcomes included sessile serrated adenoma detection rate, mean adenoma per colonoscopy, cecal intubation rate and time to reach cecum. Safety data were also analyzed. We performed pairwise meta-analysis through a random effects model and expressed data as risk ratio and 95% confidence interval. Overall, pooled adenoma detection rate was 48.1% (39.3-56.8%) with endocuff and 40.5% (30.4- 50.6%; risk ratio 1.14, 0.96-1.35) with cap. Proximal adenoma detection rate was 45.7% (36.8-54.7%) and 24% (17-45.1%) with endocuff and cap, respectively (risk ratio 2.04, 0.93-4.49), whereas endocuff outperformed cap-assisted colonoscopy in detecting diminutive (≤ 5 mm) adenomas (risk ratio 2.74, 1.53-4.90) and in terms of mean adenoma per colonoscopy (mean difference 0.31, 0.05 -0.57; p=0.02). Sessile serrated adenoma detection rate (risk ratio 1.36, 0.72-2.59), cecal intubation rate (risk ratio 0.99, 0.98-1.00), and time to reach cecum (6.87 min versus 6.87 min) were similar between the two groups. No serious adverse event was observed. Endocuff-assisted colonoscopy seems to provide a higher adenoma detection rate as compared to cap-assisted colonoscopy, in particular concerning smaller diminutive polyps.

Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial

ObjectiveEndocuff Vision (ECV) is the second generation of a device designed to improve polyp detection. The aim of this study was to evaluate its impact on adenoma detection rate (ADR)...

Endocuff-Assisted versus Cap-Assisted Colonoscopy Performed by Trainees: A Retrospective Study.

Background/AimsThe adenoma detection rate (ADR) of screening colonoscopies performed by trainees is often lower than that of colonoscopies performed by experts. The effcacy of cap-assisted colonoscopy (CAC) in adenoma detection is well documented, especially that of CACs performed by trainees. Endocuff, a new endoscopic cap, is reportedly useful for adenoma detection; however, no trials have compared the effcacy of Endocuff-assisted colonoscopy (EAC) and CAC conducted by trainees. Therefore, the present study retrospectively compared the effcacy between EAC and CAC in trainees. MethodsThis was a single-center, retrospective study involving 305 patients who underwent either EAC or CAC performed by three trainees between January and December 2018. We evaluated the ADR, mean number of adenomas detected per patient (MAP), cecal intubation rate, cecal intubation time, and occurrence of complications between the EAC and CAC groups. ResultsThe ADR was significantly higher in the EAC group than in the CAC group (54.3% vs. 37.3%, p=0.019), as was the MAP (1.36 vs. 0.74, p=0.003). No significant differences were found between the groups with respect to the cecal intubation rate or cecal intubation time. No major complications occurred in either group. ConclusionsOur results suggest that EAC exhibits increased ADR and MAP compared to CAC when performed by trainees.

Endoscopic cuff–assisted colonoscopy versus cap-assisted colonoscopy in adenoma detection: randomized tandem study—DEtection in Tandem Endocuff Cap Trial (DETECT)

Adenoma miss rate during colonoscopy is directly linked to risk of postcolonoscopy colorectal cancer. One of the reasons for missed adenomas is poor visualization of proximal folds during standard colonoscopy withdrawal. Disposable distal attachments such as the plastic cap and Endocuff (Arc Medical Design, Leeds, UK) that hold back folds appear to improve adenoma detection. The primary aim of this study was to compare adenoma detection rates between Endocuff-assisted colonoscopy (EAC) and cap-assisted colonoscopy (CAC). This is a randomized, single-center, tandem colonoscopy trial performed by the same endoscopists on the same day, first with Endocuff Vision (Arc Medical Design, Leeds, UK) followed by cap or vice versa. All procedures were performed by 3 experienced gastroenterology fellows. One hundred fifty-four patients were recruited. Seventy-eight (50.6%) had CAC as their first procedure. Mean patient age was 61 years (male-to-female ratio, 1:1). Adenoma detection rate was significantly higher for EAC when compared to CAC (53% vs 26%, P = .001). Polyp miss rate was significantly lower in EAC (8.4%) compared with CAC (26.1%, P< .001) as was adenoma miss rate (EAC vs CAC, 6%, vs 19%; P= .002) and diminutive adenoma (<5mm) miss rate in the EAC group (1.8% vs 19.6%, P< .001). However, there was no significant differences in the miss rates for small adenomas (5-9mm) (3.7% vs 2.9%, P= .69) or adenomas 10mm or larger (1.6% vs 2.6%, P= .98 ). The mean number of adenomas per procedure was significantly higher with EAC compared with CAC (1.5 vs .8, P< .001). Cecal intubation time was significantly shorter with EAC than CAC (median 6 vs 7 minutes, P= .01). Conversely, withdrawal time (median 10 vs 8 minutes, P= .01) was significantly longer in EAC. This randomized, tandem study demonstrates that EAC has a significantly higher adenoma detection rate and lower adenoma miss rate than CAC. Although insertion times were shorter with EAC, procedures were slightly more uncomfortable, and the cuff had to be removed in a small number of cases. (Clinical trial registration number: NCT03254498.).

Comparison of colon adenoma detection rates using cap-assisted and Endocuff-assisted colonoscopy: a randomized controlled trial.

Objectives and study aim Colonoscopy prevents colorectal cancer by removing adenomatous polyps, but missed adenomas lead to interval cancers. Different devices have been used to increase adenoma detection rates (ADR). Two such devices of interest are the transparent cap (Olympus) and Endocuff (ARC Medical). Our study aimed to compare differences in ADR between Endocuff-assisted colonoscopy (EAC), cap-assisted colonoscopy (CAC) and standard colonoscopy (SC). Patients and methods A sample size of 126 subjects was calculated to determine an effect size of 30 %. Patients undergoing screening or surveillance colonoscopy between March 2016 and January 2017 were randomized to SC, CAC or EAC groups. Three experienced endoscopists performed all colonoscopies. Patient demographics, procedure indication, Boston Bowel Prep Score (BBPS), withdrawal time, polyp size, location, histopathology, were analyzed. Results There was no difference in ADR (52 %, 40 % and 54 %) in the SC, CAC and EAC groups respectively ( P = 0.4). Similar findings were also observed for proximal ADR (45 %, 35 %, and 50 %, P = 0.4) and SSA detection rate (16 %, 14 %, and 23 %, P = 0.5). EAC detected higher mean ADR per colonoscopy compared to CAC (1.70 vs 0.76, P = 0.01). However, there was no significant difference in mean ADR per positive colonoscopy (2.08, 1.63, and 2.59, P = 0.21). Conclusion In a randomized controlled trial comparing AC to CAC and SC, neither device conferred additional benefits in ADR among high detectors. When comparing each device, EAC may be better than CAC at detecting more total adenomas.

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

This meta-analysis aimed to evaluate whether EndoCuff-assisted colonoscopy (EAC) could improve adenoma detection rate (ADR) compared with standard colonoscopy (SC). PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar databases were searched for articles published up to March 2019. All pure randomized controlled trials comparing ADR between EAC and SC groups were included. Dichotomous data were pooled to obtain the odds ratio with a 95% confidence interval (CI), whereas continuous data were pooled using a mean difference with 95% CI. Review Manager Version 5.3 was used for data analysis. Thirteen randomized controlled trials consisting of 9038 patients (EAC: 4574; SC: 4464) were included. The EAC group showed significant superiority over the SC group in ADR (odds ratio 1.37, 95% CI 1.15-1.62). However, there were no differences between the EAC and SC groups in adverse events, cecal intubation rate, and cecal intubation time. EAC could significantly improve ADR without increasing adverse events, especially for operators with low ADRs. In addition, no significant difference was observed in cecal intubation time and cecal intubation rate between EAC and SC.

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

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. 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. 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.

551 Comparing Advanced Adenoma Detection Rate of Water Exchange, Cap, and Endocuff Colonoscopy: Pooled Data of Randomized Controlled Trials With Air Insufflation as the Common Comparator

INTRODUCTION: Advanced adenomas, defined as adenomas ≥10mm, significant villous features (&gt;25%), or high-grade dysplasia, are important targets for colorectal cancer screening. They represent the subpopulation of adenomas that are most likely to progress into carcinoma and are associated with increased risk for future CRC incidence. Advanced adenoma detection rate (AADR) is therefore an important measure in assessing new screening methods. Water exchange (WE) colonoscopy has been shown to improve AADR consistently while modern accessories, such as cap and endocuff, have variable impacts on AADR. We assessed the impact on AADR between WE, cap and Endocuff by indirect comparison with standard air insufflation (AI) as the common comparator. METHODS: A literature search was done to identify all relevant RCTs comparing WE, Cap and Endocuff with AI colonoscopy published since 2000 as full text in English and included AADR among the outcomes. EMBASE, Medline, SCOPUS, and Cochrane Library were searched systematically using the following terms in their titles, abstracts, or keyword lists: colonoscopy, and water exchange, cap, or Endocuff. Two investigators screened the articles manually and separately. The results were compared, and a discussion was held with a third investigator to resolve any discrepancies. RESULTS: 1,453 articles resulted from keywords search and were manually screened. 14 RCTs met criteria and were included in the analysis. A total of 12,085 subjects underwent AI, WE, cap (CC) or Endocuff-assisted (EC) colonoscopy. AADR of WE, CC, and EC were compared against AI. Table 1 shows that WE significantly increases AADR compared to AI (8.1% vs 6.0%, P = 0.0001, Fisher exact test). CC does not significantly change AADR compared to AI (8.7% vs 8.2%, P = 0.585). No significant difference in AADR exists between EC and AI (16.6% vs 17.0%, P = 0.815). AADR in WE, CC, and EC as a percentage change of AI are 35.0%, 6.1% and -2.4%, respectively. While WE significantly increases AADR, CC and EC do not significantly impact AADR. Compared to CC and EC, WE has a higher percentage increase in AADR (vs the common comparator of AI). This may be related to the low AADR in the AI group in the WE trials. CONCLUSION: WE appears to significantly increase AADR, especially in patient cohort with lower AADR. Cap and Endocuff does not have significant impact on AADR.

Endocuff-assisted colonoscopy for surveillance of serrated polyposis syndrome: a multicenter randomized controlled trial.

Serrated polyposis syndrome (SPS) is a condition with high risk for colorectal cancer. The Endocuff device has been shown to increase adenoma detection in the general and screening population. We aimed to ascertain whether Endocuff-assisted colonoscopy increases detection of serrated lesions in comparison with standard colonoscopy during the surveillance of patients with SPS. METHODS: In a multicenter randomized controlled study, patients who met SPS criteria I and/or III under surveillance (previous resection of all serrated lesions ≥ 4 mm) were consecutively randomly allocated 1:1 to Endocuff-assisted colonoscopy or standard colonoscopy, performed by expert endoscopists. The main outcome was the mean number of serrated lesions detected per patient. 122 patients (standard colonoscopy n = 60; Endocuff-assisted colonoscopy n = 62; 59 % men; mean age 60.6 (standard deviation [SD] 7.5) were included at 4 centers. Baseline variables (demographic data, SPS phenotype, colorectal cancer [CRC] history, cumulative polyps, and follow-up), cecal intubation rate, and withdrawal time were similar between groups. There was no statistically significant difference between Endocuff-assisted colonoscopy and standard colonoscopy for the mean number of serrated lesions detected per patient: 5.8 (95 % confidence interval [95 %CI] 4.4 - 7.2) and 5.0 (3.9 - 6.1), respectively (P = 0.36). There were also no differences between Endocuff-assisted and standard colonoscopy for detection of sessile serrated lesions (mean number per patient 2.5 [1.3 - 3.6] vs. 2.0 [1.1 - 3.0], P = 0.54) and adenomas (0.9 [0.5 - 1.3] vs. 0.5 [0.3 - 0.7], P = 0.12). Use of Endocuff-assisted colonoscopy did not significantly increase the number of serrated lesion detected per patient during surveillance of SPS.

Su1674 ENDOCUFF COLONOSCOPY VERSUS STANDARD COLONOSCOPY FOR ADENOMA DETECTION RATE - AN UPDATED META ANALYSIS

Endocuff is a device attached to the distal end of a colonoscope, designed to maintain and maximize the viewable mucosa during colonoscopy. Recently multiple studies have been published to assess the efficacy of endocuff in increasing the adenoma detection rate (ADR). We conducted update meta-analysis of studies comparing endocuff assisted colonoscopy (EC) versus standard colonoscopy (SC) for ADR.

Serrated Lesions Detection With Endocuff-assisted Colonoscopy

Serrated Lesions Detection With Endocuff-assisted Colonoscopy