Colonoscopy / ADR

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Colonoscopy / ADR

Colorectal cancers start as adenomas
Colorectal Cancer (CRC) is the second most common cause of death from cancer in Europe and North America after lung cancer. Fifty years ago researchers discovered that most CRCs develop from adenomas; small benign outgrowths of the bowel lining that are found in about a third of all Western people aged over fifty. Not all adenomas develop into cancers, only a minority of them do but research shows that if the adenomas are removed at an early stage, the risk of cancer falls.

Adenomas are removed at colonoscopy to prevent cancer
When colonoscopy became the gold standard test for examining the bowel it was quickly realised that adenomas could be easily removed at the same time. If you now have a colonoscopy, any polyps identified will be removed and as a result, you will be less likely to develop cancer than those who have not been examined in this way.

Adenomas can be missed and cause cancer (Interval Cancers)
Unfortunately having a colonoscopy does not completely eliminate the risk of cancer, it is reduced by about 50% or 60%. The most likely reason for this is that some adenomas are missed.

Some colonoscopists detect more adenomas than others
Adenoma Detection Rate (ADR) is the percentage of patients in whom at least one adenoma is identified. ADR varies according to the group of patients studied but there is also considerable variation from one endoscopist to another. A recent study from California that assessed 136 colonoscopists showed that the ADR of individual colonoscopists performing diagnostic colonoscopy varied from 7% to 53%.

A low Adenoma Detection Rate means more interval cancers
The California study showed that interval cancers (cancers that arise after colonoscopy) were inversely related to the individual colonoscopist's ADR. There was a 3% increase in interval cancer risk and 4% increase in risk of cancer death for every 1% fall in ADR. Similar results were found in a Polish study.

Adenomas are missed if they are hiding behind folds
Some adenomas are small or flat or have an unusual appearance, they may be hidden by faecal material or lie in a difficult position where they cannot be seen. A conventional colonoscope has a small camera at its tip that faces forward. It provides views of the bowel wall as the instrument is withdrawn but the bowel is convoluted, its lining is concertinaed and thrown up into folds so it is difficult for the colonoscopist to see behind them and even large adenomas can be missed.

ENDOCUFF™ increases Adenoma Detection
ENDOCUFF™ stretches and elongates the colon during withdrawal, it flattens the small mucosal folds and retracts the larger ones enabling previously hidden polyps to be seen and at the same time it stabilises the tip, assisting with adenoma removal. ENDOCUFF™ has been used in three separate studies; in Germany ADR increased from 28% to 36% a relative improvement of 29%, In the USA from 30% to 47%, relative improvement 55% and in the UK from 49% to 66%, relative improvement of 35%.  

" The Endocuff is feasible, safe, reliable and easy to handle and might have potential to reduce the incidence of colorectal cancer "

Dr Meister, Clinical Endocrirology News Digital Network

" ...potential to become an indispensable tool of every colon cancer surveillance program "

Dr Meister, UEGW 2014

" My colleagues and I have definitely found polyps that they didn’t see with the forward view. We feel we were doing an excellent exam with current colonoscopy and that this made it better. "

Outpatient Surgery Magazine



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