James Higham-Kessler*, Gregory L. Austin, University of Colorado Denver, Aurora, CO. GIE Journal May 2016 Volume 83, Issue 5, Supplement, Page AB538
BACKGROUND AND AIMS:
The adenoma detection rate (ADR), the percentage of screening colonoscopies during which at least one adenoma is detected, has become the key quality measure for screening colonoscopy as higher ADRs have been associated with a reduction in the risk of interval colon cancer. The Endocuff, an attachment placed at the tip of a colonoscope, has been shown to increase the ADR and the mean number of adenomas in some studies. The effects of the Endocuff on colonoscopy outcomes among endoscopists with a high ADR are less clear. Furthermore, the impact on patient comfort during a colonoscopy is unknown. The purpose of this study was to assess the impact of the Endocuff on the ADR, mean number of polyps, surveillance interval recommendation, and amount of sedation for colonoscopies performed by an experienced endoscopist with a high ADR.
We performed a cohort study of consecutive patients who underwent a screening or surveillance colonoscopy with conscious sedation between December 2014 and July 2015 by a single experienced endoscopist (GA). All colonoscopies in which there was a primary or secondary indication other than colorectal cancer screening or surveillance for a history of polyps were excluded. Clinical and demographic data were extracted from the electronic medical record. Multivariable linear and logistic regression analyses were performed to assess the effect of the Endocuff on the ADR (including traditional adenomas and sessile serrated polyps), mean number of polyps, surveillance interval recommendation, and amount of sedation administered. Models were adjusted for the covariates of age, gender, and body mass index.
The cohort (nZ230) included 77 Endocuff-assisted and 153 standard colonoscopies. The overall ADR was 63.2%. The ADR was not signiﬁcantly (pZ0.57) increased with the Endocuff (67.0% ADR) compared to standard (62.7% ADR) colonoscopy (OR 1.20;95% CI: 0.63-2.30). The mean (S.E.) number of polyps was signiﬁcantly increased by 1.01 0.44 (pZ0.03) with the Endocuff, but the resulting surveillance interval recommendation was not different (pZ0.68) for colonoscopies performed with the Endocuff compared to standard colonoscopies. The amount of fentanyl (pZ0.82) and midazolam (pZ0.76) were quite similar for colonoscopies performed with and without the Endocuff.
The Endocuff appeared to be well-tolerated based on very similar amounts of fentanyl and midazolam that were administered during colonoscopies. While there was an increase in the mean number of polyps for Endocuff-assisted colonoscopies, this did not translate into an increase in the ADR or a decrease in the surveillance interval recommendation. Although some prior studies have demonstrated an increased ADR with the Endocuff, its value may be marginal for endoscopists with a high baseline ADR.