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Endoscopic cuff–assisted colonoscopy versus cap-assisted colonoscopy in adenoma detection: randomized tandem study—DEtection in Tandem Endocuff Cap Trial (DETECT)

Published:December 10, 2019DOI:https://doi.org/10.1016/j.gie.2019.11.046

      Background and Aims

      Adenoma miss rate during colonoscopy is directly linked to risk of postcolonoscopy colorectal cancer. One of the reasons for missed adenomas is poor visualization of proximal folds during standard colonoscopy withdrawal. Disposable distal attachments such as the plastic cap and Endocuff (Arc Medical Design, Leeds, UK) that hold back folds appear to improve adenoma detection. The primary aim of this study was to compare adenoma detection rates between Endocuff-assisted colonoscopy (EAC) and cap-assisted colonoscopy (CAC).

      Methods

      This is a randomized, single-center, tandem colonoscopy trial performed by the same endoscopists on the same day, first with Endocuff Vision (Arc Medical Design, Leeds, UK) followed by cap or vice versa. All procedures were performed by 3 experienced gastroenterology fellows.

      Results

      One hundred fifty-four patients were recruited. Seventy-eight (50.6%) had CAC as their first procedure. Mean patient age was 61 years (male-to-female ratio, 1:1). Adenoma detection rate was significantly higher for EAC when compared to CAC (53% vs 26%, P = .001). Polyp miss rate was significantly lower in EAC (8.4%) compared with CAC (26.1%, P < .001) as was adenoma miss rate (EAC vs CAC, 6%, vs 19%; P = .002) and diminutive adenoma (<5 mm) miss rate in the EAC group (1.8% vs 19.6%, P < .001). However, there was no significant differences in the miss rates for small adenomas (5-9 mm) (3.7% vs 2.9%, P = .69) or adenomas 10 mm or larger (1.6% vs 2.6%, P = .98 ). The mean number of adenomas per procedure was significantly higher with EAC compared with CAC (1.5 vs .8, P < .001). Cecal intubation time was significantly shorter with EAC than CAC (median 6 vs 7 minutes, P = .01). Conversely, withdrawal time (median 10 vs 8 minutes, P = .01) was significantly longer in EAC.

      Conclusions

      This randomized, tandem study demonstrates that EAC has a significantly higher adenoma detection rate and lower adenoma miss rate than CAC. Although insertion times were shorter with EAC, procedures were slightly more uncomfortable, and the cuff had to be removed in a small number of cases. (Clinical trial registration number: NCT 03254498.)

      Abbreviations:

      ADR (adenoma detection rate), AMR (adenoma miss rate), CAC (cap-assisted colonoscopy), CIT (cecal intubation), CRC (colorectal cancer), DPC (dynamic position change), EAC (Endocuff-assisted colonoscopy), EV (Endocuff Vision), MAP (mean adenomas per procedure), SC (standard colonoscopy), SSA/P (sessile serrated adenoma/polyp), WT (withdrawal time)
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      Linked Article

      • Another cuff study with more queries than clues
        Gastrointestinal EndoscopyVol. 91Issue 6
        • Preview
          Rameshshanker et al1 randomized 154 patients to undergo either Endocuff Vision-(EAC) (Arc Medical Design Ltd, Leeds, UK) or cap-assisted colonoscopy in a tandem trial, detecting significant benefits of EAC in almost all study outcomes. However, a careful reading of their report reveals methodologic caveats that undermine the validity of the conclusions.
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