Marsano J, Tzimas D, Mckinley M, Robbins D, Mammen A, Sun E, Chugh P, Razavi F, Hasan N, Buscaglia J, Bucobo J, Nagula S, Goodman A, M. P, Gross S. Gastrointest Endosc 2014; 79: AB550
Colonoscopy is the gold standard for colon cancer screening and prevention. Several new technologies have recently emerged in order to better assist gastroenterologists in their evaluation of the colonic mucosa to find and remove polyps during screening and surveillance colonoscopies. The ARC EndoCuff is a disposable plastic device with soft, hair-like projections that is placed at the tip of the colonoscope prior to the procedure (Image 1.). The device helps to stabilize the tip of the colonoscope and assists in flattening the folds of the colonic mucosa in order to better evaluate proximal colonic folds. We performed a retrospective chart review of patients who underwent screening and surveillance colonoscopy with and without EndoCuff. The aim of our study was to assess whether EndoCuff was more effective at detecting polyps and adenomas.
Patients were retrospectively analyzed at a tertiary care medical center, urban and suburban outpatient practices from September 2013 thru November 2013. Only screening and surveillance colonoscopies were included. Based on previous learning curve results, the first 4 EndoCuff procedures for each operator were excluded. A comparison group was matched to Endocuff cases based on indication. Colonoscopy reports were retrospectively reviewed to obtain demographic information, total polyps and adenomas removed. This was used to calculate overall ADR and ADR by colon location (right vs. left). Paired t-tests were performed to assess for significance between EndoCuff and comparison group with respect to total polyps and adenomas removed and ADR.
165 patients received EndoCuff and 153 patients underwent standard colonoscopy. Average polyps detected per patient in the EndoCuff group was 1.31 vs. 0.82 in standard colonoscopy (pZ!0.001). Similar results were also observed in average adenoma per patient 0.8 vs 0.38 (pZ!0.001). The ADR was highest amongst patients who underwent EndoCuff compared to standard colonoscopy (46.6% vs. 30.0%, pZ0.002). ADR was also superior with EndoCuff in right sided adenomas (32.1% vs 18.3%; pZ0.004).
This is the first United States multicenter study to compare EndoCuff to standard colonoscopy. Our initial results suggest that EndoCuff assisted colonoscopy may result in higher overall ADR and may be more effective in detecting right-sided adenomas, by allowing better inspection of proximal colonic folds. Given the limitations of retrospective analysis, further prospective studies are needed to assess the utility of EndoCuff enhanced colonoscopy.