Endocuff Vision improves adenoma detection rate in a large screening-related cohort

Abstract

Background and study aims Endocuff Vision (ECV) increases adenoma detection rate (ADR) in randomized clinical trials; however, observational effectiveness data are lacking. We evaluated the effectiveness, safety, and practical aspects of ECV use in a large screening-related real-world cohort. Patients and methods In this observational study, patients undergoing screening-related colonoscopy from November 2018 to April 2019 comprised the baseline period, and those undergoing it from June to November 2019 comprised the ECV period, where ECV use was discretionary. The primary outcome was ADR, compared: 1) between ECV use and standard colonoscopy across both periods; and 2) between time periods. Secondary outcomes included indication-specific ADR, sessile serrated ADR (SSADR), cecal intubation rate (CIR), procedure times, patient comfort scores, and sedation use. Multilevel logistic regression was performed, yielding adjusted odds ratios (AOR) with 95 % confidence intervals (CIs). Results In 15,814 colonoscopies across both time periods, ADR was 46.7 % with standard colonoscopy and 54.6 % when ECV was used ( P < 0.001). Endoscopists used ECV in 77.6 % of procedures in the ECV period, during which overall ADR rose to 53.2 % compared to 46.3 % in the baseline period ( P < 0.001). ECV use was significantly associated with higher ADR (AOR 1.24, 95 % CI 1.10 to 1.40) after adjusting for relevant covariates including time period. ECV use did not result in lower CIR, longer procedure time, increased sedation use, or poorer comfort scores. Conclusions ECV use is associated with improved ADR without negatively impacting other key procedure and patient-related factors. Future studies should evaluate the cost-effectiveness of incorporating ECV into routine screening-related practice.

Fig. 1

Study flow diagram showing exclusion criteria and final pathology and procedural cohorts included for primary and secondary outcomes. FIT, fecal immunochemical test; BBPS, Boston Bowel Preparation Score; EMR, endoscopic mucosal resection.

Fig. 2

Scatterplots of endoscopist ADRs by study period, stratified by patient FIT status and colored by physician baseline ADR quartiles among non-FIT patients. Endoscopists with fewer than 20 procedures in any of the four subcategories (n = 10) were removed.

Fig. 3

Line graphs of endoscopist ADRs by use of ECV, stratified by patient FIT status and colored by physician baseline non-FIT ADR quartiles. Endoscopists with fewer than 20 procedures in any of the four subcategories (n = 13) were removed.