Adenoma miss rate during colonoscopy is considered as a key indicator of post colonoscopy cancer. One of the main reason for missed adenoma is poor visualisation of proximal folds and flexures during standard colonoscopy. Disposable distal attachments such as cap and Endocuff showed promising results to visualise proximal aspects of folds and to improve adenoma detection. There are no comparative randomised controlled trials of those two devices in the literature to date.Aim
Primary aim of this study was to compare adenoma miss rate between Endocuff assisted colonoscopy (EAC) and Cap assisted colonoscopy (CAC).Methods
All Patients referred for a colonoscopy via symptomatic services were invited to participate in the study. This is a randomised, single centre, tandem colonoscopy trial performed by the same endoscopist, on the same day first with Endocuff Vision followed by cap or vice-versa. All procedures were performed by Gastroenterology fellows who had performed more than 1500 colonoscopies each.Results
A total of 154 patients were recruited. 78 of them had CAC as their first procedure. The mean age of participant was 61 years (male: female was 1:1). Polyp miss rate was significantly lower in EAC (8.4%) when compared with CAC (26.1%, p<0.001). Adenoma miss rate showed similar trend (EAC vs CAC, 6%, vs 19%, p=0.002). Miss rate for diminutive adenomas where significantly lower in EAC group (1.8% vs 19.6%, p<0.001), however, there was no significant differences in the miss rates for small (3.7% vs 2.9%, p=0.69) or adenomas larger than 10 mm (2.6% vs 1.6%, p=0.98). There was no significant difference in cancer, advanced adenoma or serrated polyps miss rate. The mean number adenoma per procedure was significantly higher in EAC group when compared to CAC (1.5 vs 0.8, p<0.001).Results
Caecal intubation time were significantly shorter in the EAC group than CAC group (median 6 vs 7 mins, p=0.01) Conversely, withdrawal time (median 10 vs 8 mins, p=0.01) was significantly longer in the EAC group. This difference could be due to more polyps were detected and resected in EAC group. While introducing the colonoscope via anus the discomfort score was higher in EAC (55% vs 10%, p<0.001). However, majority of them reported only a mild discomfortResults
During the first procedure, Endocuff was removed in 5/76 (6.6%) patients’ due to difficulties to pass the Endocuff through a fixed or narrowed sigmoid colon. There were no difficulties to negotiate the sigmoid colon when cap was used. There were no other colonoscopy related complications reported during the procedure.Conclusions
Our randomised, back to back study demonstrates that Endocuff assisted colonoscopy has significantly lower adenoma miss rate than cap assisted colonoscopy. Use of Endocuff appear to improve efficiency of the colonoscopy.