Anish Patel*, Jasleen K. Grewal, William E. Karnes, University of California, Irvine Medical Centre, Orange, CA, GIE Journal May 2016 Volume 83, Issue 5, Supplement, Page AB535
The Endocuff (EC) (Arc Medical Design Ltd., Leeds, England) is a recently developed cap with soft, ﬁnger-like projections that is mounted on the tip of a colonoscope. It is designed to ﬂatten colonic folds during withdrawal to improve endoscopic views and polyp detection. Use of EC is associated with improved ADR. However, its effect on polyp detection in procedures performed by GI fellows has not been assessed.
Determine if EC affects colonoscopy performance by GI fellows as measured by PDR, ADR, number of polyps per procedure, and procedure time. Methods: Colonoscopy quality data was collected prospectively at our single tertiary referral center beginning in June 2012. EC was ﬁrst implemented in Aug 2014 and utilized at the discretion of the colonoscopists. For this study, the dataset for analysis only included colonoscopies performed by GI fellows between Aug 2014 and Nov 2015, inclusive of all indications. 1049 colonoscopies met these criteria, including 597 conventional colonoscopies (CC) and 452 colonoscopies utilizing EC (EC). These two groups were compared for associations with procedure times, detection rates of all polyps (PDR), adenomas (ADR) and SSAs (SSADR), as well as the number of each polyp type found per procedure (PPP, APP and SPP for polyps, adenomas and SSAs, respectively). Signiﬁcance was determined by 2-tail Pearson Chi-Square, two-tailed Z-test, and two- tailed Z-test for proportions.
Compared to CC, EC was associated with signiﬁcantly higher PDR (79.0% vs 57.4%, p<0.0001), ADR (51.8% vs 36.3%, p<0.0001), and SSADR (13.3% vs 6.9%, pZ0.0005). Similarly, EC was associated with higher PPP (3.15 vs 1.71, p<0.0001), APP (1.59 vs 0.91, p<0.0001), and SPP (0.21 vs 0.11, pZ0.0002). Insertion times were signiﬁcantly shorter in the EC group (13.5-+8.5 min vs 14.9-+10 min, pZ0.014) but withdrawal times were marginally longer in the EC group (22.6-+13.9 min vs 21-+13.6 min, pZ0.062). Total procedure time did not differ between EC and CC (36.1+-16.3 min vs 35.9+-16.9 min, NS).
This study shows that EC when used by GI Fellows, signiﬁcantly improves key quality indicators, including PDR, ADR and SSADR, as well as the numbers of adenomas and SSAs found per colonoscopy performed. This improved quality was not compromised by inefﬁciency, as total time of procedure was not signiﬁcantly affected by use of EC. While our study was not randomized, and is subject to selection bias, our ﬁndings support encouragement of GI trainees to use assistive devices such as EC that improve adenoma detection.