BACKGROUND Endocuff-a plastic device with flexible projections-mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection.AIM To elucidate the effect of Endocuff on adenoma detection rat...BACKGROUND Endocuff-a plastic device with flexible projections-mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection.AIM To elucidate the effect of Endocuff on adenoma detection rate(ADR), advanced ADR(AADR) and mean number of adenomas per colonoscopy(MAC).METHODS Literature searches identified randomized-controlled trials evaluating Endocuffassisted colonoscopy(EAC) vs conventional colonoscopy(CC) in terms of ADR,AADR and MAC. The effect size on study outcomes was calculated using fixed or random effect model, as appropriate, and it is shown as relative risk(RR) [95%confidence interval(CI)] and mean difference(MD)(95%CI). The rate of device removal in EAC arms was also calculated.RESULTS We identified nine studies enrolling 6038 patients. All studies included mixed population(screening, surveillance and diagnostic examinations). Seven and two studies evaluated the first and the second-generation device, respectively. EAC was associated with increased ADR compared to CC [RR(95%CI): 1.18(1.05-1.32); Ι~2 = 71%]; EAC benefits more endoscopists with ADR ≤ 35% compared to those with ADR > 35% [RR(95%CI): 1.37(1.08-1.74); Ι~2 = 49% vs 1.10(0.99-1.24); Ι~2= 71%]. In terms of AADR and MAC, no difference was detected between EAC and CC [RR(95%CI): 1.03(0.85-1.25); Ι~2 = 15% and MD(95%CI): 0.30(-0.17-0.78);Ι~2 = 99%]. Subgroup analysis did not show any difference between the two device generations regarding all three endpoints. In EAC arms, the device had to be removed in 3%(95%CI: 2%-5%) of the cases mainly due to tortuous sigmoid or presence of diverticula along it.CONCLUSION EAC increases ADR compared to CC, especially for endoscopists with lower ADR. On the other hand, no significant effect on AADR and MAC was detected.展开更多
AIM To perform meta-analysis of the use of Endocuff during average risk screening colonoscopy.METHODS Scopus, Cochrane databases, MEDLINE/Pub Med, and CINAHL were searched in April 2016. Abstracts from Digestive Disea...AIM To perform meta-analysis of the use of Endocuff during average risk screening colonoscopy.METHODS Scopus, Cochrane databases, MEDLINE/Pub Med, and CINAHL were searched in April 2016. Abstracts from Digestive Disease Week, United European Gastroenterology, and the American College of Gastroenterology meeting were also searched from 2004-2015. Studies comparing EC-assisted colonoscopy(EAC) to standard colonoscopy, for any indication, were included in the analysis. The analysis was conducted by using the Mantel-Haenszel or DerS imonian and Laird models with the odds ratio(OR) to assess adenoma detection, cecal intubation rate, and complications performed. RESULTS Nine studies(n = 5624 patients) were included in the analysis. Compared to standard colonoscopy, procedures performed with EC had higher frequencies for adenoma(OR = 1.49, 95%CI: 1.23-1.80; P = 0.03), and sessile serrated adenomas detection(OR = 2.34 95%CI: 1.63-3.36; P < 0.001). There was no significant difference in cecal intubation rates between the EACgroup and standard colonoscopy(OR = 1.26, 95%CI: 0.70-2.27, I2 = 0%; P = 0.44). EAC was associated with a higher risk of complications, most commonly being superficial mucosal injury without higher frequency for perforation.CONCLUSION The use of an EC on colonoscopy appears to improve pre-cancerous polyp detection without any difference in cecal intubation rates compared to standard colonoscopy.展开更多
Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed duri...Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists.Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate(ADR),which is the most important quality indicator for colonoscopy.Increasing ADR unquestionably decreases carcinoma miss rate.Simple measures to improve ADR include among others slower withdrawal time and position change.The introduction of optical imaging innovations has improved mucosal visualization.Moreover,auxiliary devices attached to the colonoscope tip have been introduced,aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots,thereby increasing ADR.Digital image analysis using artificial intelligence is the latest approach to polyp detection.All of the above approaches have been separately evaluated concerning their effect in ADR;however,it has not been thoroughly investigated whether any benefit exists from their combined use.We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.展开更多
Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting...Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting up to almost one fourth of existing adenomas. Among reasons accounting for such failures, is the inability to meticulously visualize the colonic mucosa located either proximal to haustral folds or anatomic curves, including the hepatic and splenic flexures. In order to overcome these limitations, various colonoscope attachments aiming to improve mucosal visualization have been developed. All of them-transparent cap, Endocuff, Endocuff Vision and Endorings-are simply mounted onto the distal tip of the scope. In this review article, we introduce the rationale of their development, present their mode of action and discuss in detail the effect of their implementation in the detection of lesions during colonoscopy.展开更多
It is well-known that colonoscopy is considered the gold standard for colon cancer prevention.Although performed by experienced endoscopists,the matter remains of polyps missed during this examination.The reasons may ...It is well-known that colonoscopy is considered the gold standard for colon cancer prevention.Although performed by experienced endoscopists,the matter remains of polyps missed during this examination.The reasons may include the size,shape and location of the lesions.Many colorectal cancer screening programs have been proposed to increase the adenoma detection rate.The substantial difference between these methods is whether the improvement in vision,particularly the detection of irregularities of the mucosa,is inside the endoscope electronic components(magnification,wideangle vision,narrow band imaging,flexible spectral imaging colour enhancement,i-Scan) or outside the same,by the use of specific caps(EndoC uff,EndoV ision,Endo Rings).Endocuff is a plastic device mounted at the end of the scope with a constant vision field of the entire colon.The aim of this study is to explore the potential clinical and technical benefits of Endocuff.展开更多
文摘BACKGROUND Endocuff-a plastic device with flexible projections-mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection.AIM To elucidate the effect of Endocuff on adenoma detection rate(ADR), advanced ADR(AADR) and mean number of adenomas per colonoscopy(MAC).METHODS Literature searches identified randomized-controlled trials evaluating Endocuffassisted colonoscopy(EAC) vs conventional colonoscopy(CC) in terms of ADR,AADR and MAC. The effect size on study outcomes was calculated using fixed or random effect model, as appropriate, and it is shown as relative risk(RR) [95%confidence interval(CI)] and mean difference(MD)(95%CI). The rate of device removal in EAC arms was also calculated.RESULTS We identified nine studies enrolling 6038 patients. All studies included mixed population(screening, surveillance and diagnostic examinations). Seven and two studies evaluated the first and the second-generation device, respectively. EAC was associated with increased ADR compared to CC [RR(95%CI): 1.18(1.05-1.32); Ι~2 = 71%]; EAC benefits more endoscopists with ADR ≤ 35% compared to those with ADR > 35% [RR(95%CI): 1.37(1.08-1.74); Ι~2 = 49% vs 1.10(0.99-1.24); Ι~2= 71%]. In terms of AADR and MAC, no difference was detected between EAC and CC [RR(95%CI): 1.03(0.85-1.25); Ι~2 = 15% and MD(95%CI): 0.30(-0.17-0.78);Ι~2 = 99%]. Subgroup analysis did not show any difference between the two device generations regarding all three endpoints. In EAC arms, the device had to be removed in 3%(95%CI: 2%-5%) of the cases mainly due to tortuous sigmoid or presence of diverticula along it.CONCLUSION EAC increases ADR compared to CC, especially for endoscopists with lower ADR. On the other hand, no significant effect on AADR and MAC was detected.
文摘AIM To perform meta-analysis of the use of Endocuff during average risk screening colonoscopy.METHODS Scopus, Cochrane databases, MEDLINE/Pub Med, and CINAHL were searched in April 2016. Abstracts from Digestive Disease Week, United European Gastroenterology, and the American College of Gastroenterology meeting were also searched from 2004-2015. Studies comparing EC-assisted colonoscopy(EAC) to standard colonoscopy, for any indication, were included in the analysis. The analysis was conducted by using the Mantel-Haenszel or DerS imonian and Laird models with the odds ratio(OR) to assess adenoma detection, cecal intubation rate, and complications performed. RESULTS Nine studies(n = 5624 patients) were included in the analysis. Compared to standard colonoscopy, procedures performed with EC had higher frequencies for adenoma(OR = 1.49, 95%CI: 1.23-1.80; P = 0.03), and sessile serrated adenomas detection(OR = 2.34 95%CI: 1.63-3.36; P < 0.001). There was no significant difference in cecal intubation rates between the EACgroup and standard colonoscopy(OR = 1.26, 95%CI: 0.70-2.27, I2 = 0%; P = 0.44). EAC was associated with a higher risk of complications, most commonly being superficial mucosal injury without higher frequency for perforation.CONCLUSION The use of an EC on colonoscopy appears to improve pre-cancerous polyp detection without any difference in cecal intubation rates compared to standard colonoscopy.
文摘Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists.Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate(ADR),which is the most important quality indicator for colonoscopy.Increasing ADR unquestionably decreases carcinoma miss rate.Simple measures to improve ADR include among others slower withdrawal time and position change.The introduction of optical imaging innovations has improved mucosal visualization.Moreover,auxiliary devices attached to the colonoscope tip have been introduced,aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots,thereby increasing ADR.Digital image analysis using artificial intelligence is the latest approach to polyp detection.All of the above approaches have been separately evaluated concerning their effect in ADR;however,it has not been thoroughly investigated whether any benefit exists from their combined use.We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.
文摘Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting up to almost one fourth of existing adenomas. Among reasons accounting for such failures, is the inability to meticulously visualize the colonic mucosa located either proximal to haustral folds or anatomic curves, including the hepatic and splenic flexures. In order to overcome these limitations, various colonoscope attachments aiming to improve mucosal visualization have been developed. All of them-transparent cap, Endocuff, Endocuff Vision and Endorings-are simply mounted onto the distal tip of the scope. In this review article, we introduce the rationale of their development, present their mode of action and discuss in detail the effect of their implementation in the detection of lesions during colonoscopy.
文摘It is well-known that colonoscopy is considered the gold standard for colon cancer prevention.Although performed by experienced endoscopists,the matter remains of polyps missed during this examination.The reasons may include the size,shape and location of the lesions.Many colorectal cancer screening programs have been proposed to increase the adenoma detection rate.The substantial difference between these methods is whether the improvement in vision,particularly the detection of irregularities of the mucosa,is inside the endoscope electronic components(magnification,wideangle vision,narrow band imaging,flexible spectral imaging colour enhancement,i-Scan) or outside the same,by the use of specific caps(EndoC uff,EndoV ision,Endo Rings).Endocuff is a plastic device mounted at the end of the scope with a constant vision field of the entire colon.The aim of this study is to explore the potential clinical and technical benefits of Endocuff.
