Colorectal Cancer Prevention

37 - Endocuff Allows Shorter Colonoscopy Withdrawal Times with No Loss of Detection: A Randomized Controlled Trial

Tuesday, October 9
2:15 PM - 2:25 PM
Location: Terrace Ballroom 4 (level 400)

Category: Colorectal Cancer Prevention
Douglas K. Rex, MD, MACG1, Seth A. Gross, MD2
1Indiana University, Indianapolis, IN; 2NYU Langone Health, New York, NY

Introduction: Endocuff has improved detection at colonoscopy in most randomized controlled trials. Some uncontrolled trials have suggested that mucosal fold exposure devices can shorten withdrawal time with simultaneous gains in detection.  We performed a randomized controlled trial targeting shorter withdrawal time as the primary end point.  The hypothesis was that Endocuff would achieve complete mucosal inspection in a shorter time than standard colonoscopy without impairing lesion detection.

Methods: Patients age ≥ 40 years with screening, surveillance or diagnostic indications and intact colons were randomized to undergo colonoscopy, with or without Endocuff, by one of two experienced endoscopists at two centers in the U.S.  Gastroenterology fellows were allowed to insert the colonoscope but not to participate in withdrawal.  The goal was to achieve a subjective thorough evaluation of the proximal sides of all haustral folds, flexures and valves in the shortest time possible.  Inspection time was measured with a stopwatch and consisted of withdrawal time, with time for washing, suctioning, polypectomy and biopsy subtracted.  The study was powered to detect a 1 minute reduction in inspection time with Endocuff (requiring 100 patients in each group).

Results: 200 subjects were randomized, including 101 to Endocuff and 99 to standard colonoscopy.  There were fewer females in the Endocuff arm (43.6% vs 57.6%; p=.0475) but no other demographic differences or bowel preparation quality between groups.  Mean insertion time with Endocuff was 4.0 vs 4.4 min without (p=0.14). Mean inspection time with Endocuff was 6.49 vs 8.42 min without (p <0.0001). In multivariable analyses longer inspection time remained significant for Endocuff having shorter times ( p <0.0001), while it was also associated with increasing age (slope=1.15; p=.0286) and with male participants (7.92 vs. 7.45; p=.0040), but not with race (p=.2411).  Adenomas per colonoscopy (1.43 vs 1.07; p=0.07), adenoma detection rate (61.4% vs 52%; p=0.21), sessile serrated polyps per colonoscopy (0.27 vs 0.21; p=0.12), and sessile serrated polyp detection rate (19.8% vs 11.1%; p= 0.09) were all numerically higher with Endocuff, with similar results after controlling for age gender, and race.

Discussion: Endocuff can be utilized to decrease examination time with no loss of detection.


Disclosures:
Douglas Rex: Olympus Corp – Consultant.
Seth Gross: Olympus Corp – Consultant.

Seth A. Gross

Associate Professor of Medicine, NYU School of Medicine; Chief of Gastroenterology, Tisch Hospital
NYU Langone Medical Center
New York, NY

Seth A. Gross, MD, FACG is an Associate Professor of Medicine at NYU Medical School. He currently Chief of Gastroenterology at Tisch Hospital, which is part of the NYU Langone Medical Center. He is active both locally and nationally in the field of gastroenterology and serves on several committees within the ACG.

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