Distal Attachment Device for Colonoscopy Effective vs Standard Colonoscopy

Intestinal polyps closeup — 3D Rendering
No serious adverse events were associated with WingCap-assisted exams, a study demonstrated.

WingCap-assisted colonoscopy was tolerable and efficacious for improving adenoma detection rate (ADR) and adenoma per colonoscopy (APC) compared with standard colonoscopy, according to a study in Gastrointestinal Endoscopy.

The prospective, randomized controlled trial (RCT) sought to determine whether WingCap-assisted colonoscopy could improve ADR or APC and simultaneously shorten cecal intubation time compared with standard colonoscopy. The device combines a conventional transparent cap and a distal attachment device to flatten mucosal folds.

Participants were outpatients who visited a medical center in South Korea from December 2020 to July 2021. Eligible individuals presented for screening, surveillance, or diagnostic colonoscopy and were at least 18 years old.The primary outcome was the difference in ADR between the groups.

A total of 537 participants were randomly assigned to the WingCap and control groups, of whom 269 and 259 patients in each group, respectively, were included in the final analysis (mean age, 59.3 years; 48.5% men).

In the intention-to-treat (ITT) analysis, ADR was significantly higher in the WingCap group compared with the control group (37.2% vs 26.6%, respectively; P =.012). In addition, APC was higher in the WingCap group compared with the control group (0.72±1.34 vs 0.45±0.97, P =.008), prominently for nonpedunculated adenomas (0.65±1.25 vs 0.42±0.95, P =.015) and for diminutive adenomas (0.42±0.97 vs 0.20±0.64, P =.002), respectively.

Polyp per colonoscopy was significantly higher in the WingCap group compared with the control group (1.06±1.90 vs 0.76±1.38, P =.037), but polyp detection rate was not (46.1% vs 37.8%, P =.067).

After adjustment for other covariates in logistic regression analysis, WingCap was associated with improved detection of adenomas (adjusted odds ratio, 1.55; 95% CI, 1.04-2.31).

A subgroup analysis included 297 patients who had a screening colonoscopy, with the WingCap and control groups including 150 and 147 participants, respectively. The findings were similar to the main findings in the full cohort, as WingCap-assisted colonoscopy significantly improved ADR (36.7% vs 20.4%, P =.003) and APC (0.75±1.45 vs 0.31±0.74, P =.001) compared with standard colonoscopy. No significant difference was found in cecal intubation time (387.5 [294.8, 539.5] vs 414.0 [287.0, 625.0], respectively; P =.487).

For beginner endoscopists, a significant improvement was found in ADR (33.0% vs 18.8%, P =.031) and APC (0.61±1.24 vs 0.29±0.86, P =.039) with the use of WingCap compared with standard colonoscopy, respectively. No statistically significant interaction was observed between the endoscopist’s experience and the use of WingCap, which were independent variables for ADR (P for interaction =.501). No serious adverse events related to colonoscopy occurred in either group, such as perforation or significant mucosal tearing.

Among several study limitations, the ADR of beginner endoscopists in the control group did not reach the suggested goal of 25%. Also, the colonoscopy indications included nonscreening methods, such as surveillance, and the population included participants aged younger than 50 years.

“Our RCT demonstrated that WingCap-assisted colonoscopy, compared to standard colonoscopy, is tolerable and efficacious for the improved detection of adenomas, especially for the detection of nonpedunculated, diminutive adenomas and when used by beginner endoscopists,” stated the investigators.

Disclosure: This prototype device was manufactured and provided by A&A Medical Supply LLC. Please see the original reference for a full list of disclosures.

Reference

Hong SW, Hong HS, Kim K, et al. Improved adenoma detection by a novel distal attachment device-assisted colonoscopy: a prospective randomized controlled trial. Gastrointest Endosc. Published online April 29, 2022. doi:10.1016/j.gie.2022.04.1307