Abstract
Background
The undetected colonic lesions behind the folds and flexures are a major factor contributing to the adenoma miss rate.
Objective
To assess the efficacy of Endocuff®, a special attachment was fixed at the distal tip of a colonoscope, for the polyp detection. This soft accessory is composed of a plastic cap surrounded by flexible finger-like projections on the lateral sides of the cap that make holding of the folds during scope withdrawal easier.
Design
This was a simulated pilot study with one anatomic colorectal model, containing 13 polyps positioned in obvious locations and behind the folds. Thirty-two endoscopists (16 Japanese and 16 foreign visitors) with different levels of experience performed examinations on the model in a randomized order by using Endocuff®-assisted colonoscopy (EAC) and standard colonoscope (SC).
Main outcome measurements
To assess the detection rate of polyps and the feasibility of Endocuff® insertion.
Results
EAC detected significantly more polyps than SC with 9.9 versus 7.5 mean lesions (p = 0.03), respectively, comparing the 16 first colonoscopies in each group. Endocuff® was useful independent of the level of experience of the participants. After crossover, EAC in second position allowed an additional detection of 1.8 polyps compared with SC (p = 0.001). After adjustment on experience, time of detection, and order of colonoscopy, EAC over-detected 1.2 polyps (p = 0.0037). The insertion time (p = 0.99) was identical. There was no difference in the mean time of polyp detection between EAC and SC groups (p = 0.520).
Limitations
This was not a clinical study. The stiffness of the folds in the colonic model was higher than in the human large bowel.
Conclusion
EAC was associated with a higher polyp detection rate. Even in such relatively stiff anatomic model, it was easier to spread out the colonic mucosa between the folds using this cap. This study provides an additional argument for the routine application of this easy-to-use accessory to improve polyp detection.
Similar content being viewed by others
References
Graser A, Stieber P, Nagel D, Schäfer C, Horst D, Becker CR, Nikolaou K, Lottes A, Geisbüsch S, Kramer H, Wagner AC, Diepolder H, Schirra J, Roth HJ, Seidel D, Göke B, Reiser MF, Kolligs FT (2009) Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut 58:241–248
Heresbach D, Barrioz T, Lapalus MG, Coumaros D, Bauret P, Potier P, Sautereau D, Boustière C, Grimaud JC, Barthélémy C, Sée J, Serraj I, D’Halluin PN, Branger B, Ponchon T (2008) Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 40:284–290
Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, Lehman GA, Mark DG (1997) Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 112:24–28
Hixson LJ, Fennerty MB, Sampliner RE, Garewal HS (1991) Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps. Gastrointest Endosc 37:125–127
Rastogi A, Bansal A, Rao DS, Gupta N, Wani SB, Shipe T, Gaddam S, Singh V, Sharma P (2012) Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial. Gut 61:402–408
Matsushita M, Hajiro K, Okazaki K, Takakuwa H, Tominaga M (1998) Efficacy of total colonoscopy with a transparent cap in comparison with colonoscopy without the cap. Endoscopy 30:444–447
Gralnek IM, Segol O, Suissa A, Siersema PD, Carr-Locke DL, Halpern Z, Santo E, Domanov S (2013) A prospective cohort study evaluating a novel colonoscopy platform featuring full-spectrum endoscopy. Endoscopy 45:697–702
Uraoka T, Tanaka S, Matsumoto T, Matsuda T, Oka S, Moriyama T, Higashi R, Saito Y (2013) A novel extra-wide-angle-view colonoscope: a simulated pilot study using anatomic colorectal models. Gastrointest Endosc 77:480–483
Lenze F, Beyna T, Lenz P, Heinzow HS, Hengst K, Ullerich H (2014) Endocuff-assisted colonoscopy: a new accessory to improve adenoma detection rate? Technical aspects and first clinical experiences. Endoscopy 46:610–614
Biecker E, Floer M, Heinecke A, Ströbel P, Böhme R, Schepke M, Meister T (2014) Novel Endocuff-assisted colonoscopy significantly increases the polyp detection rate: a randomized controlled trial. J Clin Gastroenterol. [Epub ahead of print]
Gralnek IM, Carr-Locke DL, Segol O, Halpern Z, Siersema PD, Sloyer A, Fenster J, Lewis BS, Santo E, Suissa A, Segev M (2013) Comparison of standard forward-viewing mode versus ultrawide-viewing mode of a novel colonoscopy platform: a prospective, multicenter study in the detection of simulated polyps in an in vitro colon model (with video). Gastrointest Endosc 77:472–479
Floer M, Biecker E, Fitzlaff R, Röming H, Ameis D, Heinecke A, Kunsch S, Ellenrieder V, Ströbel P, Schepke M, Meister T (2014) Higher adenoma detection rates with Endocuff-assisted colonoscopy—a randomized controlled multicenter trial. PLoS One 9:e114267
Gralnek IM, Siersema PD, Halpern Z, Segol O, Melhem A, Suissa A, Santo E, Sloyer A, Fenster J, Moons LMG, Dik VK, D’Agostino RB, Rex DK (2014) Standard forward-viewing colonoscopy versus full-spectrum endoscopy: an international, multicentre, randomised, tandem colonoscopy trial. Lancet Oncol 15:353–360
DeMarco DC, Odstrcil E, Lara LF, Bass D, Herdman C, Kinney T, Gupta K, Wolf L, Dewar T, Deas TM, Mehta MK, Anwer MB, Pellish R, Hamilton JK, Polter D, Reddy KG, Hanan I (2010) Impact of experience with a retrograde-viewing device on adenoma detection rates and withdrawal times during colonoscopy: the Third Eye Retroscope study group. Gastrointest Endosc 71:542–550
Triadafilopoulos G, Watts HD, Higgins J, Van Dam J (2007) A novel retrograde-viewing auxiliary imaging device (Third Eye Retroscope) improves the detection of simulated polyps in anatomic models of the colon. Gastrointest Endosc 65:139–144
Hewett DG, Rex DK (2011) Miss rate of right-sided colon examination during colonoscopy defined by retroflexion: an observational study. Gastrointest Endosc 74:246–252
Pishvaian AC, Al-Kawas FH (2006) Retroflexion in the colon: a useful and safe technique in the evaluation and resection of sessile polyps during colonoscopy. Am J Gastroenterol 101:1479–1483
Tsiamoulos ZP, Saunders BP (2012) A new accessory, endoscopic cuff, improves colonoscopic access for complex polyp resection and scar assessment in the sigmoid colon (with video). Gastrointest Endosc 76:1242–1245
Acknowledgments
This work was supported in part by The National Cancer Center Research and Development Fund (25-A-12). We would like to acknowledge the efforts of all the doctors listed below who participated to the study: Alessandro Lavagna (Italy), Alejandro Hernandez (Spain), Tomoko Okamoto (Japan), Kazuya Inoki (Japan), Genki Mori (Japan), Masayoshi Yamada (Japan), Dmitrii Mtrashvili (Russia), Egor Korolevsky (Russia), Liu Chengxia (China), Yue Zeng (China), Harry Aslanian (USA), Said Elmuhtady (UK), Ash Solimar (UK), Olga Buntseva (Russia), Ekaterina Ivanova (Russia), Hsion Le Puo (Tai Wan), Laura Martin Asenjo (Spain), Chi-kun Chiang (Tai Wan), Nobuaki Ikezawa (Japan), Emese Mihaly (Hungary), Masau Sekiguchi (Japan), Hirohito Tanaka (Japan), Hajime Takisawa (Japan), and Masanori Sekiguchi (Japan). We also acknowledge Dr. Hadrien Charvat (NCCH, Japan) and Masanori Nojima (Japan) for their advices for statistics calculations and Dr. Magdalena Metzner for the English edition of this manuscript.
Disclosures
Drs. Pioche, Matsumoto, Takamaru, Sakamoto, Nakajima, Abe, Matsuda, Kakugawa, Otake, and Saito have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pioche, M., Matsumoto, M., Takamaru, H. et al. Endocuff®-assisted colonoscopy increases polyp detection rate: a simulated randomized study involving an anatomic colorectal model and 32 international endoscopists. Surg Endosc 30, 288–295 (2016). https://doi.org/10.1007/s00464-015-4208-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4208-8