Shawn Kaye*, Mohit Mittal, Katherine Kim, William E. Karnes, GIE 2016 Vol. 83, No 58 AB231
Each 1.0% increase in adenoma detection rate (ADR) predicts a 3.0% decrease in the risk of interval cancer. 80% of interval cancers are presumed to arise from missed and incompletely removed precancerous lesions. Interval cancers are predominantly right-sided and have molecular features of the serrated pathway (BRAF mutations and CIMP). The putative precursors are sessile serrated adenomas (SSA), which are predominately right sided, easily missed and often incompletely removed. Endocuff (Arc Medical Designs, Leeds, United Kingdom) is a novel attachment device which has been shown to signiﬁcantly increase ADR. Few studies have addressed the utility of Endocuff (EC) for the detection of SSAs.
Compare SSA detection rates with and without EC.
Colonoscopy quality data from sixteen gastroenterologists and colorectal surgeons was collected prospectively at our single tertiary referral center from June 2012 to November 2015. Inclusion criteria included all screening and surveillance examinations (excluding inﬂammatory bowel disease). SSA detection rate (SSADR) and number of SSAs detected per procedure (#SSA/Proc) were compared among three groups: 1) conventional colonoscopy prior to EC implementation (CC-Pre); 2) conventional colonoscopy after EC was implemented (CC-Post); and 3) cases that used EC (EC). Polyp location was divided into right sided (proximal colon up to splenic ﬂexure) and left sided (splenic ﬂexure to distal colon). Results: 4212 patients, 4535 procedures and 8959 polyps were analysed. 3375 procedures met inclusion criteria (2043 screening and 1332 surveillance colonoscopies). 544 SSAs were conﬁrmed by histology. In total, EC was associated with a 58.7% and 46.0% increase in SSADR compared to CC-Pre and CC-Post, respectively (P<0.0001, PZ0.0065). In the right colon, EC was associated with a 68.5% (P<0.0001) and 46.4% (PZ0.013) increase in SSADR, and an increased number of SSAs per procedure of 63.6% (P<0.0001) and 50.0% (PZ0.001) compared to CC-Pre and CC-Post, respectively. In the left colon, EC was associated with non-statistically signiﬁcant increases in SSADR and number of SSAs per procedure.
This prospective nonrandomized observational study demonstrates a signiﬁcant association between EC-assisted colonoscopy and increased SSADR and number of SSAs identiﬁed per procedure overall, especially in the right colon. While this study is limited by its nonrandomized nature and retrospective analysis, ﬁndings are compelling and support use of assistive devices that improve detection of SSAs that may reduce interval colorectal cancers.