Wolfson Unit for Endoscopy, St Mark's Hospital/Academic Institute, East Kent University Foundation Hospitals Trust, London, United Kingdom.
Ballarat Health Services and Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Gastrointest Endosc. 2018 Jan;87(1):280-287. doi: 10.1016/j.gie.2017.04.001. Epub 2017 Apr 13.
Distal attachments placed on the colonoscope tip may positively affect performance by assisting insertion and polyp detection. The original Endocuff (ARC Medical Design, Leeds, United Kingdom) appears to improve adenoma detection rate (ADR), but no data assess the performance of the second-generation Endocuff Vision.
A pilot service evaluation study (April 2013 to September 2014) was conducted on patients with positive fecal occult blood tests within the National Bowel Cancer Programme during 3 consecutive periods: precuff/no device used, during-cuff/device used, and postcuff/no device used. During the middle period the use of the Endocuff Vision by the 4 screening-accredited colonoscopists was discretional (nonrandomized design). Data were analyzed using pairwise comparisons during the 3 designated periods to examine key performance indicators: adenoma detection, procedural time, sedation requirements, and patient comfort.
Four hundred ten complete colonoscopies were performed (137 precuff, 136 cuff, and 137 postcuff period). Overall, there was a notable increase in the mean ADR of 16% (P < .03) and in the mean number adenoma per procedure (MAP) of 83% (P = .007) from precuff to cuff period. The mean cecal intubation time was statistically lower during the cuff period (7 minutes) in relation to the precuff period (8 minutes; reduction of 12.5%, P = .002) and the postcuff period (9 minutes; increase of 28.6%, P = .002). The mean negative colonoscopy withdrawal time was also significantly lower during the cuff period (8 minutes, 30 seconds) when compared with the precuff (12 minutes) or postcuff period (9 minutes, 45 seconds; P ≤ .001). Multivariate regression analysis showed that the use of the Endocuff Vision was not associated with sedation requirements or patient discomfort scores. No adverse events were reported from the use of the Endocuff Vision, although it was electively removed in 6 patients where severe sigmoid colon diverticulosis was encountered and 2 patients because of discomfort during anal insertion.
In this pilot service evaluation study, the use of the Endocuff Vision appears to be associated with an improvement in overall colonoscopy operator performance. We found increased ADR and MAP as well as decreased time for colonoscope insertion and withdrawal time with no increase in sedation requirements or patient discomfort.
在结肠镜尖端放置远端附件可能通过辅助插入和息肉检测来提高性能。最初的 Endocuff（ARC Medical Design，英国利兹）似乎可以提高腺瘤检出率（ADR），但没有数据评估第二代 Endocuff Vision 的性能。
一项试点服务评估研究（2013 年 4 月至 2014 年 9 月）在全国结直肠癌计划中对粪便潜血试验阳性的患者进行，共分为三个连续阶段：预罩/无装置使用、罩中/装置使用和罩后/无装置使用。在中间阶段，4 名经过筛查认证的结肠镜检查医师可以自由使用 Endocuff Vision（非随机设计）。使用配对比较分析 3 个指定时间段内的关键性能指标：腺瘤检出率、程序时间、镇静要求和患者舒适度。
共完成 410 例完整结肠镜检查（预罩 137 例、罩中 136 例、罩后 137 例）。总体而言，腺瘤检出率（ADR）平均提高 16%（P<0.03），平均每例手术检出的腺瘤数（MAP）提高 83%（P=0.007），从预罩期到罩中期。与预罩期（8 分钟）和罩后期（9 分钟）相比，罩期的盲肠插管时间统计学上更低（7 分钟；减少 12.5%，P=0.002）。与预罩期（12 分钟）或罩后期（9 分钟，45 秒；P≤0.001）相比，罩期的阴性结肠镜退出时间也显著降低（8 分钟，30 秒）。多变量回归分析显示，使用 Endocuff Vision 与镇静要求或患者不适评分无关。虽然在 6 例严重乙状结肠憩室病和 2 例因肛门插入时不适的患者中，选择性地移除了 Endocuff Vision，但没有报告使用 Endocuff Vision 后出现不良事件。
在这项试点服务评估研究中，使用 Endocuff Vision 似乎与整体结肠镜操作性能的提高有关。我们发现 ADR 和 MAP 增加，结肠镜插入和退出时间减少，而镇静要求或患者不适没有增加。
