David García, Coty Gonzalez-Fernandez, Rafael Barreto-Zuñiga, Nancy E. Aguilar-Olivos, Adriana F. Romano, Guido Grajales-Figueroa, Felix I. Tellez-Avila Gastrointestinal Endoscopy, National Institute of Medical Sciences and Nutrition “Salvador Zubiran”, Mexico City, Mexico May 2016 Volume 83, Issue 5, Supplement, Page AB193
Colorectal cancer (CRC) is one of the leading causes of death world- wide. Many techniques have been implemented to improve the vision of the endoscopist in order to attempt a greater detection of adenomas. The “endocuff” (EC) is a polymer sleeve cap which joins the tip of the colonoscope in order to improve the image display of the mucosa during colonoscopy procedure. AIM: To compare the adenoma detection rate (ADR) with the EC cap compared to conventional colonoscopy (CC).
This is a randomized clinical trial that was conducted at a single tertiary care center. From April 2014 thru November 2015 patients with CRC screening were included. We prospectively enrolled 337 patients [248 females, mean age 61 years (IQR 55-68)]. Enrolment ﬂow chart is seen in Figure 1. Patients were randomized into two groups: endocuff-assisted colonoscopy group (EC group) and conventional colonoscopy without endocuff (CC group). ADR was deﬁned as the proportion of screening colonoscopies with histopathological diagnosis of at least one adenoma or carcinoma. Polyp detection rate (PDR) was deﬁned as the pro- portion of screening colonoscopies with histopathological diagnosis of at least one polyp. Descriptive statistics were used for demographic characteristics. Continuous variables were analysed using Student’s t test or Wilcoxon rank-sum-Mann Whitney. For categorical variables we used the chi-squared test. A p value less than 0.05 was considered statistically signiﬁcant.
There was a higher ADR in patients of the EC group compared with patients in the CC group (22.4% vs 13.4%, p Z 0.034). The polyp detection rate (PDR) was higher in the EC group compared with the CC group (29.9% vs 15.9%, p Z0.002). Adenoma and polyp analysis in shown in Table 1. Signiﬁcantly more polyps between the size of 5 mm and 1 cm were detected in the EC group (45.4% vs 31.6%, pZ0.037) as well as more ﬂat polyps (16.7% vs 7.9%, p
0.039). Patients in the EC group had a signiﬁcantly higher right colon polyp detection rate (35.5% vs 30.1%, p Z 0.006). There were no statistical differences between the two groups in terms of age, gender, colonoscope used, quality of bowel preperation according to the Boston Bowel Preparation Scale (BBPS) and time of withdrawal. The cecal intubation time decreased signiﬁcantly in the EC group compared to the CC group (10 minutes vs 12 minutes, p Z 0.002). However, the rate of ileal intubation was statistically lower in the EC group (75% vs 92%, p Z <0.001). In the majority of colonoscopies, no adverse events occurred in either group.
According with our data, the EC increased the ADR by 67%. The EC is useful tool for adenoma detection rate that is safe, effective, and easy to use. Trial Registration: ClinicalTrials.gov NCT023875