Cuff- and cap-assisted colonoscopy of no benefit over high-definition colonoscopy for adenomas: Study

USA: A new study showed that even with high-detector endoscopists, there is no substantial benefit in utilizing either distal attachment device (CF or CP) over high-definition white light colonoscopy (HDWLE). In the screening population, the Endocuff may offer an advantage. This study was conducted by Prateek Sharma and the team, the results of which were published in Clinical Gastroenterology and Hepatology, on 31st December 2021.

When compared to high-definition white light colonoscopy, mucosal exposure devices, including distal attachments such as the cuff and cap, have shown varying outcomes in enhancing adenoma detection rates (ADRs) when compared to HDWLE.

Researchers conducted a prospective, multicenter randomized controlled experiment in individuals having screening or surveillance colonoscopy to compare HDWLE to two types of distal attachments: cuff (CF) (Endocuff Vision) or cap (CP) (Reveal). ADR was the key result. Secondary outcomes were the number of adenomas detected per colonoscopy, the incidence of advanced adenoma and sessile serrated lesion detection, right-sided ADR, withdrawal time, and adverse events. Using the statistical programme Stata version 16, continuous variables were compared using the Student's t test, and categorical variables were compared using the chi-square or Fisher's exact test. A P value of.05 was deemed significant.

The key findings of this work were as follow:

1. A total of 1203 people were randomly assigned to either HDWLE, CF, or CP. There were no significant differences in ADR, adenomas per colonoscopy, advanced adenoma, sessile serrated lesion, or right ADR among the three groups.

2. The number of polyps per colonoscopy in the CF group was considerably greater than in the HDWLE and CP groups.

3. After correcting for age, gender, BMI, withdrawal duration, and Boston Bowel Preparation Scale score, there was no effect of device type on the primary outcome of ADR (P =.77) in a multivariable model.

4. CF led in more neoplasms per colonoscopy with a quicker pullout time in screening individuals.

In conclusion, this randomized trial found no significant advantage to employing a distal attachment such as a cap or cuff for high ADR endoscopists. People with CF may have an edge when it comes to screening populations.

Reference:

High-Definition Colonoscopy Compared with Cuff- and Cap-Assisted Colonoscopy: Results from a Multicenter, Prospective, Randomized Controlled Trial. Desai, Madhav et al. 2021, https://doi.org/10.1016/j.cgh.2021.12.037