Distal Attachment Cuff Increases ADR in Primary Screening Colonoscopy

A distal attachment cuff may significantly increase the adenoma detection rate (ADR) in patients undergoing primary colonoscopic screening, according to a study inGastrointestinal Endoscopy.

Researchers evaluated the Endocuff Vision (ECV) device for colonoscopic adenoma detection in patients undergoing screening colonoscopy at multiple centers in Germany from September 2017 to November 2020.

Eligible participants were aged over 55 years and voluntarily underwent a screening colonoscopy. Patients were randomly assigned 1:1 to preventive colonoscopy without the attachment cap (control group) or preventive colonoscopy with the Endocuff attachment cap. The device is attached to the distal end of the colonoscope with the goal of optimizing the view of the mucosa with shaped, flexible rubber arms that smooth the colonic folds on withdrawal.

The main outcome was the difference in adjusted ADR between the 2 groups.

A total of 1416 patients were included (mean age, 61.1 years; women, 51.8%); 700 were in the ECG group and 716 were in the control group.

The ECV group had a higher adjusted ADR (39.5%; 95% CI, 32.6%-46.3%) compared with the control group (32.2%; 95% CI, 25.9%-38.6%; P =.004). For adenomas less than 10 mm, the adjusted ADR was 33.3% (95% CI, 26.5%-40.2%) in the ECV group and 24.0% (95% CI, 18.2%-29.8%) in the control group (P <.001).

For adenomas at least 10 mm, no significant difference was found in adjusted ADR between the ECV group (9.7%; 95% CI, 6.8%-12.6%) and the control group (11.3%; 95% CI, 8.2%-14.5%; P = .338), resulting in an overall ADR for adenomas greater than 1cm of 10.5% (95% CI, 8.0%-13.1%).

No influence of adenoma location or morphology was observed, and the sessile serrated lesion rate was not significantly different between the 2 groups. Also, the ECV did not increase the rate of hyperplastic polyps. The overall polyp detection rate was 47.2% (95% CI, 40.2%-54.1%) in the ECV group and 39.2% (95% CI, 32.5%-45.9%) in the control group (P <.002).

Study limitations include the potential for individual examiner bias, and the study periods and included cases varied among the centers. In addition, no monitoring of inclusion completeness was done, and the researchers did not use uniform bowel preparation, which could be regarded as a methodologic limitation.

“Our results add to the increasing evidence that Endocuff is a useful addition to diagnostic colonoscopy and especially in screening patients to improve its main outcome quality parameter, namely ADR,” the study authors wrote. “This is in line with previous studies in other or mixed indications and our results may be relevant for reimbursement purposes, especially since screening colonoscopy is regarded differently from the diagnostic examination with regards to cost-benefit considerations.”