IMPACT OF SECOND GENERATION ENDOCUFF-ASSISTED COLONOSCOPY VS. STANDARD COLONOSCOPY ON ADENOMA DETECTION RATE IN ROUTINE PRACTICE: A CLUSTER-RANDOMIZED CROSSOVER TRIAL

Aims Endocuff vision (ECV) is the second generation of a recent device designed to improve polyp detection. The aim of this study was to evaluate the impact of ECV on adenoma detection rate (ADR) in routine colonoscopy.

Methods This cluster-randomized crossover trial compared endocuff-assisted (ECV+) to standard (ECV-) colonoscopy. Two teams of 11 endoscopists each were formed. They were balanced in terms of basal ADR, gender and volume of activity. The team that started with ECV+ was selected based on randomization. Once half the inclusions had been treated, a switch was made and the other team performed ECV+. The main criterion was ADR.

Results 2,058 patients were included (1,032 ECV- vs. 1,026 ECV+). Both groups were comparable. Taking into account the cluster crossover design, we observed a 9.8% [5.7;13.8] increase in ADR in the ECV+ group (29.4% vs. 39.2%, P < 0.001), mostly when polyps < 1 cm.

Regarding the physicians’ basal ADR, the only significant increase was observed in the “good detectors” group (31% vs. 41%, P < 0.001), but there was no significant increase in the “bad detectors” group (24% vs. 30%, P=0.11). ECV had a positive impact in all colonic sectors, except the rectum. Cecal intubation time was significantly lower with ECV (P < 0.001). No complication due to ECV were reported in this study.

Conclusions We observed a significant increase of approximately 10% in ADR in the ECV+ group. ECV had a very significant positive impact in the “good detectors”, but not in the “bad detectors”.

Trial registered at ClinicalTrials.gov (NCT03344055).