No Benefit of Endocuff Vision in Screening Flexible Sigmoidoscopy
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No Benefit of Endocuff Vision in Screening Flexible Sigmoidoscopy

Douglas K. Rex, MD, FASGE, reviewing Rees CJ, et al. Gut 2020 Apr 3.

Endocuff Vision (EV) has well-established benefits in colonoscopy, both for improved detection and faster withdrawal without reduced detection. 

EV has not been tested for its benefits in flexible sigmoidoscopy. In a randomized controlled trial in the UK, 3222 participants were randomized to screening flexible sigmoidoscopy with EV or without. The adenoma detection rate (ADR) was numerically, but not significantly, higher with EV than without (13.3% vs 12.2%; P=.35). Withdrawal time with EV (mean=3.32 minutes) was not different than without EV (mean=3.44 minutes). The average reach of the sigmoidoscope without EV was further than with EV (P<.001), and discomfort scores were greater with EV attached to the sigmoidoscope.

Douglas K. Rex, MD, FASGE

COMMENT

The authors believed that the failure to demonstrate improved detection with EV was because the control group’s ADR was high – about 3% higher than the national average for flexible sigmoidoscopy. However, this remains unproven as the underlying cause. The risk of increased discomfort and less reach using EV with the sigmoidoscope in unsedated patients seems understandable. For now, the use of EV for screening flexible sigmoidoscopy cannot be recommended.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Rees CJ, Brand A, Ngu WS, et al. BowelScope: Accuracy of Detection using Endocuff Optimisation of Mucosal Abnormalities (the B-ADENOMA Study): a multicentre, randomised controlled flexible sigmoidoscopy trial. Gut 2020 Apr 3. (Epub ahead of print) (https://doi.org/10.1136/gutjnl-2019-319621)

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