Background and study aims: The adenoma detection rate (ADR) is one of the quality measures in screening colonoscopy
and is crucial for reducing colorectal cancer morbidity and mortality. Up to 25 %
of adenomas are missed during colonoscopy. Endocuff is an easy-to-use device that
is attached like a cap to the distal tip of the colonoscope in order to optimize visualization
behind the folds of the colon and increase the ADR. This is the first prospective
study of Endocuff-assisted colonoscopy (EC) in a screening population with follow-up
to determine the ADR and adverse events of EC.
Patients and methods: We prospectively enrolled asymptomatic patients referred for screening colonoscopy
during the 4-month study period. We documented the Boston Bowel Preparation Scale
(BBPS) score, cecal intubation rate, polyp detection rate, ADR, number of advanced
adenomas, and number of adverse events. Colonoscopies were performed by five board-certified
gastroenterologists. During follow-up, the patients were called 4 to 12 weeks after
EC.
Results: A total of 104 EC procedures were performed. Cecal intubation was achieved in 99 %
of the patients, with a median intubation time of 6 minutes. The polyp detection rate
and ADR in our study were 72 % and 47 %, respectively, and 13.5 % of the lesions were
advanced adenomas. A significant number of adenomas were detected in the right side
of the colon. Considering all the adenomas and hyperplastic polyps above the sigmoid,
we recommended that nearly 60 % of our patients repeat an endoscopic follow-up according
to the existing Swiss guidelines. We noted no perforations or other serious adverse
events, even in the patients with extensive diverticulosis.
Conclusions: EC is feasible with the most commonly available colonoscopes without severe adverse
events. EC seems to be a safe and effective device for increasing the ADR, including
small adenomas in the right side of the colon. Therefore, this technique may be recommended
in the future to increase the ADR in a screening population.
