Background and Aims
WingCap (A&A Medical Supply LLC, Seongnam, South Korea) is a novel distal attachment
device for colonoscopy that combines a cap and an existing mucosal exposure device,
such as Endocuff Vision (Arc Medical Design Ltd, Leeds, UK) and AmplifEYE (Medivators
Inc, Minneapolis, Minn, USA). We aimed to investigate whether WingCap-assisted colonoscopy
can improve the adenoma detection rate (ADR) and adenoma per colonoscopy (APC) and
simultaneously shorten cecal intubation time compared with standard colonoscopy.
Methods
We conducted a single-center, prospective, randomized controlled trial for outpatients
aged ≥18 years undergoing colonoscopy. The primary outcome was ADR differences with
the assistance of WingCap. Secondary outcomes were APC and other colonoscopy quality
indicators, such as cecal intubation and withdrawal times.
Results
In total, 537 patients were randomized for WingCap-assisted or standard colonoscopy.
Their mean age was 59.3 years, and 48.5% were men. ADR was significantly higher in
the WingCap group than in the control group (37.2% vs 26.6%, P = .012). APC was greater with WingCap than with standard colonoscopy (.72 ± 1.34
vs .45 ± 0.97, P = .008), prominently for nonpedunculated (.65 ± 1.25 vs .42 ± .95, P = .015) and diminutive (.42 ± .94 vs .20 ± .64, P = .002) adenomas. With WingCap, ADR and APC significantly increased for beginner
endoscopists, whereas a modest increase was seen for experienced endoscopists. There
were no differences in cecal intubation and withdrawal times between the 2 arms. No
serious adverse event was associated with the use of WingCap.
Conclusions
WingCap-assisted colonoscopy was tolerable and efficacious for improving ADR and APC
compared with standard colonoscopy, especially for nonpedunculated and diminutive
adenomas and for beginner endoscopists. (Clinical trial registration number: KCT0005214.)
Abbreviations:
ADR (adenoma detection rate), APC (adenoma per colonoscopy), ITT (intention to treat), PDR (polyp detection rate), RCT (randomized controlled trial), SSPDR (sessile serrated polyp detection rate)To read this article in full you will need to make a payment
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References
- Effect of screening colonoscopy on colorectal cancer incidence and mortality.Clin Gastroenterol Hepatol. 2009; 7 (quiz 11): 770-775
- Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty.J Clin Oncol. 2012; 30: 2664-2669
- Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.N Engl J Med. 2012; 366: 687-696
- Quality indicators for colonoscopy.Am J Gastroenterol. 2006; 101: 873-885
- Adenoma detection rate and risk of colorectal cancer and death.N Engl J Med. 2014; 370: 2539-2540
- Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial.Gut. 2019; 68: 280-288
- A comparison of 2 distal attachment mucosal exposure devices: a noninferiority randomized controlled trial.Gastrointest Endosc. 2019; 90: 835-840
- Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial.Gut. 2020; 69: 2159-2164
- AmplifEYE assisted colonoscopy versus standard colonoscopy: a randomized controlled study.J Gastroenterol Hepatol. 2021; 36: 376-382
- Efficacy of cap-assisted colonoscopy in comparison with regular colonoscopy: a randomized controlled trial.Am J Gastroenterol. 2009; 104: 41-46
- Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials.Endosc Int Open. 2018; 6: E1214-E1223
- Standard versus Endocuff versus cap-assisted colonoscopy for adenoma detection: a randomised controlled clinical trial.United Eur Gastroenterol J. 2021; 9: 443-450
- The Boston Bowel Preparation Scale: a valid and reliable instrument for colonoscopy-oriented research.Gastrointest Endosc. 2009; 69: 620-625
- Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology. 2020; 158: 1131-1153
- Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline—update 2020.Endoscopy. 2020; 52: 687-700
- Endocuff-assisted vs standard colonoscopy in the fecal occult blood test-based UK Bowel Cancer Screening Programme (E-cap study): a randomized trial.Endoscopy. 2017; 49: 1043-1050
- Impact of a new distal attachment on colonoscopy performance in an academic screening center.Gastrointest Endosc. 2018; 87: 280-287
- Second-generation distal attachment cuff improves adenoma detection rate: meta-analysis of randomized controlled trials.Gastrointest Endosc. 2021; 93: 544-553
- Adenoma detection by Endocuff-assisted versus standard colonoscopy in an organized screening program: the “ItaVision” randomized controlled trial.Endoscopy. 2022; 54: 138-147
- Higher adenoma detection rates with Endocuff-assisted colonoscopy—a randomized controlled multicenter trial.PLoS One. 2014; 9: e114267
- Endocuff-assisted colonoscopy is associated with a lower adenoma miss rate: a multicenter randomized tandem study.Endoscopy. 2017; 49: 1051-1060
- Risk of developing proximal versus distal colorectal cancer after a negative colonoscopy: a population-based study.Clin Gastroenterol Hepatol. 2008; 6 (quiz 064): 1117-1121
- Postcolonoscopy colorectal cancers are preventable: a population-based study.Gut. 2014; 63: 957-963
- Causes of post-colonoscopy colorectal cancers based on World Endoscopy Organization system of analysis.Gastroenterology. 2020; 158: 1287-1299
- Effect of Endocuff-assisted colonoscopy on adenoma detection rate: meta-analysis of randomized controlled trials.Endoscopy. 2018; 50: 846-860
- Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist.Gastrointest Endosc. 2015; 81: 517-524
- High prevalence of sessile serrated adenomas in contemporary outpatient colonoscopy practice.Intern Med J. 2017; 47: 318-323
- Sessile serrated lesions in patients with adenoma on index colonoscopy do not increase metachronous advanced adenoma risk.Dig Endosc. 2022; 34: 850-857
- Prevalence and risk factors for sessile serrated lesions in an average risk colorectal cancer screening population.J Gastroenterol Hepatol. 2021; 36: 1656-1662
- Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE).Endoscopy. 2012; 44: 957-968
Article info
Publication history
Published online: April 29, 2022
Accepted:
April 21,
2022
Received:
September 26,
2021
Footnotes
DISCLOSURE: All authors disclosed no financial relationships. Research support for this study (S-W Hong, S-W Hwang, B-D Ye, S-J Myung, and J-S Byeon) was provided by A&A Medical Supply LLC (for manufacturing and providing the prototype device) and by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (2021R1A6A1A03040260).
See CME section; p. 563.
Identification
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