Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2019; 25(9): 1158-1170
Published online Mar 7, 2019. doi: 10.3748/wjg.v25.i9.1158
Effect of Endocuff use on colonoscopy outcomes: A systematic review and meta-analysis
Konstantinos Triantafyllou, Paraskevas Gkolfakis, Georgios Tziatzios, Ioannis S Papanikolaou, Lorenzo Fuccio, Cesare Hassan
Konstantinos Triantafyllou, Paraskevas Gkolfakis, Georgios Tziatzios, Ioannis S Papanikolaou, Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens 12462, Greece
Lorenzo Fuccio, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna 40138, Italy
Cesare Hassan, Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome 00153, Italy
Author contributions: Triantafyllou K designed research; Gkolfakis P and Tziatzios G performed research; Triantafyllou K contributed new reagents or analytic tools; Triantafyllou K, Gkolfakis P, Tziatzios G and Papanikolaou I analyzed data; Triantafyllou K, Gkolfakis P, Tziatzios G, Papanikolaou I, Fuccio L and Hassan C wrote the paper.
Conflict-of-interest statement: All authors declare no conflict-of-interest.
Data sharing statement: All data related to this study are available upon request. The review’s protocol can be accessed at the International Prospective Register of Systematic Reviews (PROSPERO), under registration number CRD42018095779.
PRISMA 2009 Checklist statement: Authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ioannis S Papanikolaou, MD, PhD, Academic Fellow, Assistant Professor, Attending Doctor, Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, 1 Rimini Street, Athens 12462, Greece. ispapn@hotmail.com
Telephone: +30-210-5832087 Fax: +30-210-5326454
Received: December 28, 2018
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
Abstract
BACKGROUND

Endocuff - a plastic device with flexible projections - mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection.

AIM

To elucidate the effect of Endocuff on adenoma detection rate (ADR), advanced ADR (AADR) and mean number of adenomas per colonoscopy (MAC).

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Adenoma detection rate; Colonoscopy; Adenoma; Detection; Endocuff; Endocuff-Vision

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.