Endocuff®-assisted colonoscopy increases polyp detection rate: a simulated randomized study involving an anatomic colorectal model and 32 international endoscopists

Background The undetected colonic lesions behind the folds and flexures are a major factor contributing to the adenoma miss rate. Objective To assess the efficacy of Endocuff ® , a special attachment was fixed at the distal tip of a colonoscope, for the polyp detection. This soft accessory is composed of a plastic cap surrounded by flexible finger-like projections on the lateral sides of the cap that make holding of the folds during scope withdrawal easier. Design This was a simulated pilot study with one anatomic colorectal model, containing 13 polyps positioned in obvious locations and behind the folds. Thirty-two endoscopists (16 Japanese and 16 foreign visitors) with different levels of experience performed examinations on the model in a randomized order by using Endocuff ® -assisted colonoscopy (EAC) and standard colonoscope (SC). Main outcome measurements To assess the detection rate of polyps and the feasibility of Endocuff ® insertion. Results EAC detected significantly more polyps than SC with 9.9 versus 7.5 mean lesions ( p = 0.03), respectively, comparing the 16 first colonoscopies in each group. Endocuff ® was useful independent of the level of experience of the participants. After crossover, EAC in second position allowed an additional detection of 1.8 polyps compared with SC ( p = 0.001). After adjustment on experience, time of detection, and order of colonoscopy, EAC over-detected 1.2 polyps ( p = 0.0037). The insertion time ( p = 0.99) was identical. There was no difference in the mean time of polyp detection between EAC and SC groups ( p = 0.520). Limitations This was not a clinical study. The stiffness of the folds in the colonic model was higher than in the human large bowel. Conclusion EAC was associated with a higher polyp detection rate. Even in such relatively stiff anatomic model, it was easier to spread out the colonic mucosa between the folds using this cap. This study provides an additional argument for the routine application of this easy-to-use accessory to improve polyp detection.