Published online Mar 7, 2019. doi: 10.3748/wjg.v25.i9.1158
Peer-review started: December 29, 2018
First decision: January 30, 2019
Revised: February 8, 2019
Accepted: February 15, 2019
Article in press: February 15, 2019
Published online: March 7, 2019
Processing time: 69 Days and 18 Hours
Endocuff - a plastic device with flexible projections - mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection.
To elucidate the effect of Endocuff on adenoma detection rate (ADR), advanced ADR (AADR) and mean number of adenomas per colonoscopy (MAC).
Literature searches identified randomized-controlled trials evaluating Endocuff-assisted colonoscopy (EAC) vs conventional colonoscopy (CC) in terms of ADR, AADR and MAC. The effect size on study outcomes was calculated using fixed or random effect model, as appropriate, and it is shown as relative risk (RR) [95% confidence interval (CI)] and mean difference (MD) (95%CI). The rate of device removal in EAC arms was also calculated.
We identified nine studies enrolling 6038 patients. All studies included mixed population (screening, surveillance and diagnostic examinations). Seven and two studies evaluated the first and the second-generation device, respectively. EAC was associated with increased ADR compared to CC [RR (95%CI): 1.18 (1.05-1.32); Ι2 = 71%]; EAC benefits more endoscopists with ADR ≤ 35% compared to those with ADR > 35% [RR (95%CI): 1.37 (1.08-1.74); Ι2 = 49% vs 1.10 (0.99-1.24); Ι2 = 71%]. In terms of AADR and MAC, no difference was detected between EAC and CC [RR (95%CI): 1.03 (0.85-1.25); Ι2 = 15% and MD (95%CI): 0.30 (-0.17-0.78); Ι2 = 99%]. Subgroup analysis did not show any difference between the two device generations regarding all three endpoints. In EAC arms, the device had to be removed in 3% (95%CI: 2%-5%) of the cases mainly due to tortuous sigmoid or presence of diverticula along it.
EAC increases ADR compared to CC, especially for endoscopists with lower ADR. On the other hand, no significant effect on AADR and MAC was detected.
Core tip: Colonoscopy is the optimal diagnostic modality for the detection and removal of colon adenomas. However, one fourth of them may remain undetected during conventional colonoscopy (CC). Endocuff - a single-use device mounted onto the tip of the scope - aims to improve lesion detection rate during colonoscopy. Our meta-analysis of nine randomized control studies including more than 6000 patients demonstrates the use of the Endocuff device significantly improves adenoma detection rate compared to CC, while endoscopists with lower adenoma detection rate may benefit at most from its use.