David J. Hass, Chris Jaffe, Lucia Malangone, Paul Feuerstadt, 2016 Gastroenterology , Volume 150 , Issue 4 , S28
Increasing usage of colonoscopy has reduced the incidence of colon cancer and its resultant mortality. Endocuff (EC), an attachment to the distal tip of the colonoscope has shown improved polyp and adenoma detection rates in a non-United States population. Our hypothesis was that EC would improve polyp and adenoma detection rates in an outpatient population undergoing colonoscopy in the United States.
We performed a prospective randomized controlled trial of consecutive patients presenting to the Endoscopy Center of Connecticut with the following indications: screening, surveillance, bright red blood per rectum, constipation and abdominal pain. Each patient was randomized to either receive the EC or not. Demographics, family history, indications for the procedure, characteristics of the case, complications and outcomes were recorded. The two groups were compared (SPSS 23.0). Outcomes were also compared (SPSS 23.0) for sub-groups including screening, surveillance, adenoma on last colonoscopy and any history of polyps.
1067 patients were screened and 562 met inclusion. When comparing the two groups, there were no differences in demographics, past medical history, past surgical history, family history of colon polyps, family history of other cancers, prior colonoscopic history or indications for the procedure. EC had a higher frequency of 1st degree relative with colon cancer < 50 (3.2%, 0.7%, p <0.05). There were no differences in the type of bowel preparation used or the Boston Bowel Preparation scores. Withdrawal time was significantly lower in EC compared with no-EC (9.96 ± 5.48, 11.13±5.89 mins, p<0.05). Frequency of bleeding was similar with an increased rate of mild mucosal trauma in EC (8.3%, 0.0%, p<0.001). No other complications were noted. EC showed a trend toward a higher overall polyp detection (62.9%, 59.6%, p=0.41) and higher sessile serrated adenoma detection (11.2%, 8.9%, p= 0.37) but no statistically significant difference in adenoma detection rate (42.4%, 44.7%, p=0.59). In the sub-group analysis considering screening and any history of a polyp,
there were no differences in outcomes. EC had a higher detection rate for any adenoma > 1 cm in the surveillance cohort (6.4%, 0.8%, p<0.05) and those with adenoma on last colonoscopy (9.6%, 1.4%, p<0.05).
EC is a safe device that increases adenoma detection rates in patients with prior history of adenomatous polyps >1cm. The device also yields similar adenoma detection rates overall with shorter withdrawal times, thereby increasing colonoscopic efficiency.