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Endocuff Reduces Colonoscopy Withdrawal Time Without Sacrificing Detection
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Compared with standard colonoscopy, use of the Endocuff Vision device decreases withdrawal time without sacrificing lesion detection, according to research published in Clinical Gastroenterology and Hepatology.
Douglas K. Rex, MD, of the division of gastroenterology and hepatology at Indiana University School of Medicine, and colleagues wrote that the ability of the Endocuff Vision (Olympus) device to expose the mucosa for inspection and increase polyp detection also helped reduce most of the work an endoscopist must perform during an examination.
“Video recording studies demonstrate that high-quality colonoscope withdrawal consists of careful inspection of the proximal sides of haustral folds, flexures and colorectal valves, removal of retained pools of debris and fluid, and adequate colonic distention,” they wrote. “Devices such as Endocuff can be used to hook and flatten haustral folds, improving mucosal exposure. However, an additional benefit of these devices is to make the process of examining between folds faster.”
Researchers randomly assigned patients to undergo screening or surveillance with the device (n = 101) or standard colonoscopy (n = 99). Two experienced endoscopists performed the colonoscopies and aimed for a thorough evaluation of the proximal side of all haustral folds, flexures and valves in the shortest amount of time. They measured withdrawal time with a stopwatch and subtracted washing, suctioning, polypectomy and biopsy times from the total time.
Investigators found that the mean inspection time was nearly 2 minutes shorter for the device group (6.5 minutes vs. 8.4 minutes; P < .0001).
The device also helped achieve a higher number of adenomas detected per colonoscopy (1.43 vs. 1.07; P = .07) and adenoma detection rate (61.4% vs. 52%; P = .21), as well as number of sessile serrated polyps (0.27 vs. 0.21; P = .12) and sessile serrated polyp detection rate (19.8% vs. 11.1%; P = .09).
Although some of the differences were not significant, Rex and colleagues wrote that if the study had a larger sample size, they might be able to demonstrate that the device is faster and improves detection.
“We and others have previously demonstrated in what are typically much larger studies, that when inspection times are forced to be equal, Endocuff results in statistically significant gains in detection,” they wrote. “The absolute reduction in overall mean withdrawal time with Endocuff Vision, including polypectomy and all washing and suctioning, was 1 minute, despite a one-third increase in the number of conventional adenomas and sessile serrated polyps removed in the Endocuff Vision arm.” – by Alex Young
Disclosures: Rex reports being a consultant for Olympus Corp. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Zachary L. Smith, DO
There have been significant efforts investigating devices, techniques and other means by which to improve the detection of colon polyps, especially those that are flat, serrated, and located in the right colon. Distally-attaching accessories such as the Endocouff Vision (Olympus) allows for a more thorough examination of the colon, improving the visualization of the mucosa between and behind haustral folds. Several studies, including many randomized-controlled trials, have demonstrated higher adenoma detection rates (ADR) with the use of Endocuff, especially in users with low-to-moderate ADRs at baseline.
This study by Rex et al. randomly assigned 200 adults undergoing screening or surveillance colonoscopy to Endocuff or standard colonoscopy. The use of Endocuff was associated with significantly shorter withdrawal times, while concomitantly demonstrating non-significant trends toward higher adenomas per colonoscopy, ADR, serrated polyps per colonoscopy and serrated polyp detection rate. As the authors willingly admit, the study was underpowered to detect significant differences in these detection rate metrics.
A withdrawal time of 6 minutes has long been considered the minimum to ensure an adequate examination of the colon. This benchmark is based in part on a large single-group study of over 7,800 colonoscopies that was published in 2006. The results of this study beg the question whether this 6-minute standard can be challenged without compromising polyp detection metrics. As the authors mention in the study, for efficient endoscopists and procedure units, even small improvements in withdrawal times could account for significant increases in efficiency over time. One would anticipate larger upcoming randomized-controlled trials that may attempt to better answer this question.
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