Abstract

Background: Although colonoscopy has been the preferred modality for both screening and prevention of colorectal cancer, it remains an imperfect tool as it may fail to detect polyps and cancers. Among other reasons, this can occur due to poor visualization behind folds and flexures of the mucosa. To overcome these limitations,the endocuff is a plastic device with flexible projections that is mounted on the tip of he scope that promises improved colonic mucosa inspection. Aim: We aimed to compare the polyp detection rate (PDR), adenoma detection rate (ADR) and serrated polyp detection rate (SDR) among endocuff-assisted colonoscopy (EAC) and conventional colonoscopy (CC). Methods: This was a retrospective, single-center study done atan academic endoscopy unit in Chile. We compared performance between EAC and CC interms or PDR, ADR, and SDR. All colonoscopies were done by a unique expert endoscopist. Consecutive EACs were performed to every adult outpatient admitted for an elective colonoscopy between July and August 2019. We gathered 107 eligible patients forthe EAC group that were retrospectively paired by sex and age with 107 patients who underwent CC between January to June 2019. The colonoscopes used in this study were Olympus scopes CFH180L/1 adult scope, which used the ARV120 (Green) Endocuff Vision model (Arc Medical Design, Leeds, UK). Information was recorded, including bowel preparation quality of the colonoscopy, size, location, and histology of every polyp detected. PDR, ADR, and SDR were determined for each group and compared; adjustment was made for potential confounders such as age, sex, cigarette smoking, family history of CCR and procedural setting. PDR, ADR, and SDR were compared by different risk factors through X2 test and multivariable logistic regression. Results: A total of 214 colonoscopies were reviewed. Baseline variables were similar in both groups (nZ107 both groups,women 68%, mean age 57.9 years). PDR was significantly higher in the EAC group (PDR33.6% vs 21.5%, p<0.05). Both ADR and SDR were also higher in the EAC group but did not reach statistical significance (ADR 23.36% vs 16.82%, pZ0.15; SDR 15% vs 8.4%,pZ0.10). EAC detected a higher proportion of patients with polyps (Odds ratio [OR]Z1.89, 95%CI [1.02–3.50], p<0.05) and remained significant after adjustment for patient characteristics and risk factors (adjusted odds ratio [aOR]=2.11, 95%CI [1.07–4.15], p<0.05). There were no adverse events related to the procedures. Conclusions:The use of the EAC improves significantly PDR compared to CC. Although ADR and SDR were also higher in the EAC group, these findings did not reach statistical significance. As an additional observation, there were no endocuff-related adverse events and EAC was non-inferior to CC in other markers of comfort and procedure time .