Second-Generation Endocuff Versus Distal Cap Versus Standard High-Definition White-Light: No Overall Difference but More Detected Adenomas and Shorter Withdrawal Times in Screening Exams With Endocuff
Douglas K. Rex, MD, MASGE, reviewing Desai M, et al. Clin Gastroenterol Hepatol 2021 Dec 31.
This study from 3 U.S. centers is the first to compare the second-generation Endocuff Vision (Olympus America, Center Valley, Penn, USA) to distal cap (Reveal; STERIS, Mentor, Ohio, USA) and high-definition white-light endoscopy (HDWLE).
There were 1142 randomized subjects (81.3% male) included in the analysis and approximately 20 endoscopists.
Adenoma detection rates (ADRs) were high in all 3 arms at 57.3% for HDWLE, 59.1% for Endocuff, and 55.7% for the distal cap. There were no differences between the groups for advanced ADR, sessile serrated lesion detection rate, or right-sided colon ADR. Among the 46% of subjects undergoing screening, there was a trend toward higher ADR with Endocuff at 56.8% versus HDWLE at 47.7% versus distal cap at 44.2% (P=.051). Adenomas per colonoscopy was higher with Endocuff in the screening population (1.7) compared with HDWLE (1.3) and distal cap (1.2) (P=.048). Further, withdrawal time trended toward a shorter duration with Endocuff, a difference that reached significance for the overall study at 8.4 minutes versus 9.8 minutes with HDWLE and 8.6 with distal cuff (P=.02).
COMMENTThis study suggests that the previously described benefits of increased detection and shorter withdrawal time with Endocuff Vision may be limited to lower-prevalence populations, ie, screening. There also is mixed evidence that mucosal exposure devices have greater benefit for low-level detectors (of which there were none in this study). There also, undoubtedly, is an operator dependence on the benefits of mucosal exposure devices, which may depend on how effectively they are used to probe the proximal sides of haustral folds. Indeed, the ultimate determinant of whether an individual endoscopist or group of endoscopists benefit from using a mucosal exposure device may depend on those endoscopists measuring the impact of the device on their own detection.
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)
Desai M, Rex DK, Bohm ME, et al. High-definition colonoscopy compared to cuff- and cap-assisted colonoscopy: results from a multi-center, prospective, randomized controlled trial. Clin Gastroenterol Hepatol 2021 Dec 31. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2021.12.037)
