The impact of Endocuff Vision on adenoma detection rates in colonoscopy

Abstract

Background
One of the problems with colonoscopy is its imperfection due to variation in operator dependent adenoma detection rates. Low adenoma detection rates are linked to increased interval colorectal cancer rates and reduced cancer survival. Devices to enhance mucosal visualisation and improve adenoma detection rates such as Endocuff Vision have been developed. The primary aim of this study was to compare adenoma detection rates between Endocuff Vision-assisted colonoscopy and standard colonoscopy.

Methods
A multicentre, randomised controlled trial in seven hospitals in the United Kingdom was undertaken. Patients aged 18 and above referred for colonoscopy due to symptoms, colonoscopy surveillance, or as part of the Bowel Cancer Screening Programme following a positive screening faecal occult blood test were invited to the study. Patients with a suspicion of bowel obstruction, known colon cancer, polyposis syndromes, known strictures, active colitis, on anticoagulant therapy during the procedure, pregnant, attending for a therapeutic procedure or assessment of a known lesion were excluded.

Findings
One thousand, seven hundred and seventy-two patients (57% male, mean age 62) were recruited from November 2014 until February 2016. Patient characteristics were comparable between trial arms. Endocuff Vision increased adenoma detection rates by 4.7% (p=0.02). This was largely driven by an increase in adenoma detection rates in screening patients from 50.9% to 61.7% (p<0.001). Endocuff Vision-assisted colonoscopy also detected more mean adenomas per procedure, left sided adenomas, sessile serrated adenomas, diminutive adenomas, small adenomas and cancers. Cuff removal rate was 4.1%. Median intubation time was one minute quicker with Endocuff Vision- assisted colonoscopy (p=0.001). Anal intubation was rated as more uncomfortable with Endocuff Vision-assisted colonoscopy. There were no significant cuff-related adverse events. Endocuff Vision- assisted colonoscopy was non-inferior to SC in other markers of comfort and procedure time.

Conclusion
Endocuff Vision significantly improved ADR driven by an improvement in the faecal occult blood test positive screening population. Endocuff Vision-assisted colonoscopy was non-inferior in all aspects other than discomfort on anal intubation.