Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens 12462, Greece.
Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna 40138, Italy.
World J Gastroenterol. 2019 Mar 7;25(9):1158-1170. doi: 10.3748/wjg.v25.i9.1158.
Endocuff - a plastic device with flexible projections - mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection.
To elucidate the effect of Endocuff on adenoma detection rate (ADR), advanced ADR (AADR) and mean number of adenomas per colonoscopy (MAC).
Literature searches identified randomized-controlled trials evaluating Endocuff-assisted colonoscopy (EAC) 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.
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); = 71%]; EAC benefits more endoscopists with ADR ≤ 35% compared to those with ADR > 35% [RR (95%CI): 1.37 (1.08-1.74); = 49% 1.10 (0.99-1.24); = 71%]. In terms of AADR and MAC, no difference was detected between EAC and CC [RR (95%CI): 1.03 (0.85-1.25); = 15% and MD (95%CI): 0.30 (-0.17-0.78); = 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.
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.
Endocuff 是一种带有柔性突起的塑料装置，安装在结肠镜的远端尖端上，承诺可改善结肠黏膜检查。
阐明 Endocuff 对腺瘤检出率（ADR）、高级腺瘤检出率（AADR）和每例结肠镜检查的平均腺瘤数（MAC）的影响。
文献检索确定了评估 Endocuff 辅助结肠镜检查（EAC）与常规结肠镜检查（CC）在 ADR、AADR 和 MAC 方面的随机对照试验。使用固定或随机效应模型计算研究结果的效应大小，并以相对风险（RR）[95%置信区间（CI）]和平均差异（MD）（95%CI）表示。还计算了 EAC 臂中设备去除的速率。
我们确定了九项纳入 6038 名患者的研究。所有研究均纳入了混合人群（筛查、监测和诊断检查）。七项和两项研究分别评估了第一代和第二代设备。与 CC 相比，EAC 与更高的 ADR 相关[RR（95%CI）：1.18（1.05-1.32）； = 71%]；与 ADR ≤ 35%的内镜医生相比，EAC 对 ADR > 35%的内镜医生更有益[RR（95%CI）：1.37（1.08-1.74）； = 49% 和 1.10（0.99-1.24）； = 71%]。就 AADR 和 MAC 而言，EAC 与 CC 之间无差异[RR（95%CI）：1.03（0.85-1.25）； = 15%和 MD（95%CI）：0.30（-0.17-0.78）； = 99%]。亚组分析未显示两种设备在所有三个终点方面存在任何差异。在 EAC 臂中，由于乙状结肠弯曲或存在憩室，需要将设备移除 3%（95%CI：2%-5%）。
与 CC 相比，EAC 可提高 ADR，尤其是对 ADR 较低的内镜医生。另一方面，在 AADR 和 MAC 方面未检测到明显影响。
