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
ARTICLE HIGHLIGHTS
Research background

Although colonoscopy is the optimal diagnostic modality for colorectal cancer screening, it still remains imperfect since almost one fourth of colonic adenomas are not detected during conventional colonoscopy (CC). Endocuff is a single-use device mounted onto the tip of the scope devised to flatten mucosa folds; thus, promising to improve the detection of precancerous lesions.

Research motivation

To date, Endocuff is the add-on device with the most available literature. Despite that, whether it has beneficial impact on adenoma detection rate during colonoscopy still remains elusive. Data both from individual studies and contemporary meta-analysis remain conflicting, showing a small albeit incremental benefit of its use.

Research objectives

We aimed to systematically review the literature for published randomized controlled trials and re-evaluate the impact of Endocuff on adenoma detection rate (ADR), through a meta-analysis addressing the limitations of previous meta-analysis conducted on this matter.

Research methods

We performed an electronic search in PubMed and the Cochrane Central Register of Controlled Trials electronic databases (from database inception to October 2018) using the free text terms “adenoma*”, “random*” both as medical subject headings and free-text terms combined with the Boolean set operator ‘AND’ with the term: “Endocuff”, as medical subject heading and the free text term. We restricted our search to prospective, randomized controlled in design, published as full text in the English language. To identify further relevant studies, we checked the reference lists of the selected articles.

Research results

We ultimately identified nine studies that matched the search criteria. enrolling 6038 patients. Of note, mixed population (screening, surveillance and diagnostic examinations) was included in all of them. Endocuff-assisted colonoscopy (EAC) was associated with increased ADR compared to CC and was of particular benefit for endoscopists with ADR lower than 35%. Regarding all other study outcomes (advanced ADR and mean number of adenomas per colonoscopy), no difference between the two modalities was evident. Similarly, multiples subgroup analysis did not show any difference between the two device generations regarding all three endpoints.

Research conclusions

This meta-analysis of high-quality studies indicates that EAC improves ADR compared to CC and it is significantly more valuable for endoscopists with a low-to moderate ADR (ADR ≤ 35%). EAC is also a powerful tool in the hands of high adenoma detectors (ADR > 35%), as it seems to improve the mean number of adenomas per colonoscopy.

Research perspectives

Although promising, more robust data are definitely warranted in order to systematically assess the performance of Endocuff. A significant issue that remains in future studies to be addressed is the efficacy of the device in terms of screening colonoscopy, since no study has been conducted in an exclusively screening population yet. Moreover, its true value in terms of cost-benefit is not clear yet, especially in comparison to other low-cost techniques.