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Introduction
The adenoma detection rate (ADR) is one of the quality measures in screening colonoscopy and 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 cap-like to the distal tip of the colonoscope in order to optimize the visualisation behind the folds and increase the ADR. This is the first prospective study with Endocuff-assisted colonoscopy (EC) in a screening population with follow-up to determine ADR and adverse events of EC.
Materials 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), caecal intubation rate, polyp detection rate, ADR, number of advanced adenomas and adverse events. Colonoscopies were performed by 5 board certified gastroenterologists. Follow-up was performed by calling the patients 4-12 weeks after EC.
Results
A total of 104 ECs were performed. Caecal intubation could be achieved in 99% with a median intubation time of 6 min. The polyp detection rate (PDR) and ADR in our study was 72% and 47%, respectively with 13,5% advanced adenoma. A significant number of adenoma was detected in the right colon. Considering all adenoma and hyperplastic polyps above the sigmoid, we recommended nearly 60% of our patients to repeat an endoscopic follow-up according to the existing Swiss guidelines. We noted no perforation or other serious adverse events, even in the case of extensive diverticulosis.
Summary
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 colon. Therefore, this technique may be recommended in the future to increase the ADR in a screening population.