Effect of Endocuff use on colonoscopy outcomes: A systematic review and meta-analysis

Table 1 Characteristics of included studies

Author (yr)	Country	Study period	Centres, n	Endoscopists, n	Device	Endoscopes	Patients, n	EAC/CC, n/n	Indication	Female EAC/CC, n (%)	Age EAC/CC, mean ± SD	Screening EAC/CC, n (%)	Bowel Preparation EAC/CC
Floer et al[15]	Germany	02.2014-07.2014	4	10	Endocuff	HD	492	249/243	Mixed	127 (51)/134 (55.1)	64 ± 3.2/63 ± 3.3	NR	11 (1-2)/1 (1-2) [median (IQR)]
Van Doorn et al[16]	Netherlands	08.2013-10.2014	5	20	Endocuff	HD	1063	530/533	Mixed	266 (50.2)/248 (46.5)	65 ± 2.2/65 ± 2.3	201 (37.9)/197 (36.9)	29 (7-9)/8 (7-9) [median (IQR)]
Biecker et al[17]	Germany	02.2013-08.2013	2	6	Endocuff	HD	498	245/253	Mixed	127 (51.8)/122 (48.2)	65 ± 3.3/68 ± 3	NR	169% good/65% good
De Palma et al[18]	Italy	02.2015 -03.2016	1	4	Endocuff	HD	274	137/137	Mixed	66 (48.2)/65 (47.4)	55 ± 12.6/55.7 ± 12.3	32 (23.4)/29 (21.2)	7.08 ± 1.06/7.18 ± 0.97 [mean ± SD]
Bhattacharyya et al[19]	United Kingdom	09.2014-09.2015	1	4	Endocuff Vision	HD	531	266/265	FOBT (+) screening, surveillance	104 (39.1)/85 (32.1)	68 ± 1.2/67 ± 1.2	180 (70.7)/186 (69.1)	3Good/adequate 97.7% /Good adequate 97.7%
González-Fernández et al[20]	Mexico	04.2014-11.2015	1	18	Endocuff	Mixed	337	174/163	Screening	124 (71)/124 (76)	60 ± 1.8/62 ± 2.5	174 (100)/163 (100)	27 (6-8)/7 (6-8) [median (IQR)]
Ngu et al[21]	United Kingdom	11.2014-02.2016	7	48	Endocuff Vision	Not reported	1772	888/884	FOBT (+) screening, surveillance	381 (42.9)/ 382 (43.2)	61.7 ± 11.7/62.1 ± 11.1	274 (30.9)/282 (32)	NR
Wada et al[22]	Japan	04.2015-09.2015	1	1	Endocuff	HD	477	239/238	Mixed	117 (48.9)/123 (51.7)	61.2 ± 3.3/62.2 ± 3.3	89 (37.2)/74 (31.1)	27.91 ± 0.94/7.88 ± 1.03 [mean ± SD]
Rex et al[23]	United States, Italy	NR	3	3	Endocuff	HD	594	299/295	Mixed	141 (47) /141 (47)	63.2 ± 8.2/62.6 ± 8.3	126 (42)/127 (43)	28.12 ± 1.33 overall, no differences between the 2 groups

¹Based on Leighton et al[25] scale (1 = good; 2 = fair; 3 = poor);

²Boston Bowel Preparation Scale[24] ;

³Based in Rees et al[26] scale. EAC: Endocuff-assisted colonoscopy; CC: Conventional colonoscopy; HD: High definition; SD: Standard deviation; FOBT: Fecal occult blood test; Mixed: Screening, surveillance and diagnostic cases.

Table 2 Multiple sensitivity analysis for outcomes with detected heterogeneity

Sensitivity analysis	ADR, I2% (P value)/RR (95%CI)	MAC, I2% (P value)/MD (95%CI)
None performed	71 (< 0.001)	99 (< 0.001)
	1.18 (1.05-1.32)	0.30 (-0.17-0.78)
By excluding one study at a time
Floer et al[15]	61 (0.008)/1.13. (1.02-1.26)	97 (< 0.001)/0.36 (-0.08-0.79)
Van Doorn et al[16]	69 (0.002)/1.22 (1.07-1.38)	99 (< 0.001)/0.32 (-0.20-0.85)
Biecker et al[17]	73 (< 0.001)/1.17 (1.03-1.32)	79 (< 0.001)/0.17 (0.01-0.33)
De Palma et al[18]	74 (< 0.001)/1.19 (1.06-1.35)	ΝΑ
Bhattacharrya et al[19]	68 (0.003)/1.22 (1.08-1.38)	99 (< 0.001)/0.36 (-0.16-0.88)
González-Fernández et al[20]	71 (< 0.001)/1.16 (1.03-1.30)	ΝΑ
Ngu et al[21]	75 (< 0.001)/1.20 (1.04-.38)	99 (< 0.001)/0.32 (-0.21-0.86)
Wada et al[22]	66 (0.005)/1.14 (1.02-1.28)	99 (< 0.001)/0.28 (-0.25-0.80)
Rex et al[23]	74 (< 0.001)/1.19 (1.04-1.37)	99 (<0.001)/0.30 (-0.21-0.82)
By indication of examinations
Screening ≤ 50%[16,18,21-23]	63 (0.03)/1.31 (1.01-1.27)	22 (0.28)/0.27 (0.15-0.40)
Screening > 50%[19,20]	80 (0.02)/1.21 (0.70-2.09)	ΝΑ
By generation of device
First generation Endocuff[15-18,20,22,23]	73 (0.001)/1.25 (1.07-1.46)	100 (< 0.001)/0.39 (-0.20-0.98)
Endocuff Vision[19,21]	68 (0.08)/1.05 (0.90-1.23)	53 (0.14)/0.11 (-0.12-0.34)
By ADR of the conventional colonoscopy group
≤ 35%[15,17,18,20]	49 (0.12)/1.37 (1.08-1.74)	100 (< 0.001)/0.50 (-0.48-1.48)
> 35%[16,19,21-23]	71 (0.008)/1.10 (0.99-1.24)	49 (0.10)/0.22 (0.08-0.37)

ADR: Adenoma detection rate; MAC: Mean number of adenomas per colonoscopy; RR: Relative risk; CI: Confidence interval; MD: Mean difference.