Elsevier

Gastrointestinal Endoscopy

Volume 91, Issue 4, April 2020, Pages 894-904.e1
Gastrointestinal Endoscopy

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

https://doi.org/10.1016/j.gie.2019.11.046Get rights and content

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.)

Section snippets

Study design

A prospective, randomized, tandem study was conducted between April 2016 and May 2017 in a single endoscopy unit in the United Kingdom. The DEtection in Tandem Endocuff Cap Trial (DETECT) protocol was reviewed and approved by the East of England (Cambridge) ethics committee on the January 4, 2016 (Reference 15/EE/0415). The study was registered with clinical trial.gov (NCT03254498) and International Standard Randomized Controlled Trials (ISRCTN 58994883).

Participants

Patients older than 18 years and

Results

Three hundred eighteen patients were invited to participate in the study. One hundred sixty-four patients were excluded because they either did not meet the inclusion criteria (55%) or declined to undergo tandem colonoscopies on the same day (39%). We recruited 154 patients (mean age, 61.3± 13.6 years) with equal sex distribution (men, 51%), and the trial flow chart is shown in Figure 5. Main indications for a colonoscopy were adenoma surveillance (28%), recent change in bowel habits (21%),

Discussion

This is the first tandem, crossover, randomized trial to compare EAC with CAC. The primary aim was to compare ADR, and our results highlighted that EAC significantly improved detection of adenomas by 27% compared with CAC (P = .001). The total number of polyps detected by EAC was significantly higher than that detected by CAC (153 vs 58, P < .001). Furthermore, EAC improved the detection of missed adenomas by 13% (EAC, 6%; CAC, 19%) and SSAs/Ps by 3% compared with CAC. Our findings were

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    DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: R. Rameshshanker: Consultant for Aquilant Pvt Ltd, UK, and Norgine Ltd, UK. Z. Tsiamoulos: Consultant for Olympus Pvt Ltd, UK, Norgine Ltd, UK, Creo Medical Ltd, UK, Pentax Medical UK, and ARC Design UK. B.P. Saunders: Consultant for Norgine Ltd, Olympus Medical Ltd, UK, Creo Medical Ltd, UK, Boston Scientific, and Diagmed Ltd. All other authors disclosed no financial relationships.

    If you would like to chat with an author of this article, you may contact Dr Rameshshanker at [email protected].

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