Facciorusso Antonio, Buccino Vincenzo R, Sacco Rodolfo
Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
J Gastrointestin Liver Dis. 2020 Sep 9;29(3):415-420. doi: 10.15403/jgld-1239.
Several add-on devices have been developed to increase rates of colon adenoma detection. We aimed to compare the endocuff-assisted colonoscopy with cap-assisted colonoscopy through a pairwise meta-analysis of randomized trials.
We searched the PubMed/Medline and Embase database through March 2020 and identified 6 randomized controlled trials (comprising 2,027 patients). The primary outcome was adenoma detection rate; secondary outcomes included sessile serrated adenoma detection rate, mean adenoma per colonoscopy, cecal intubation rate and time to reach cecum. Safety data were also analyzed. We performed pairwise meta-analysis through a random effects model and expressed data as risk ratio and 95% confidence interval.
Overall, pooled adenoma detection rate was 48.1% (39.3-56.8%) with endocuff and 40.5% (30.4- 50.6%; risk ratio 1.14, 0.96-1.35) with cap. Proximal adenoma detection rate was 45.7% (36.8-54.7%) and 24% (17-45.1%) with endocuff and cap, respectively (risk ratio 2.04, 0.93-4.49), whereas endocuff outperformed cap-assisted colonoscopy in detecting diminutive (≤ 5 mm) adenomas (risk ratio 2.74, 1.53-4.90) and in terms of mean adenoma per colonoscopy (mean difference 0.31, 0.05 -0.57; p=0.02). Sessile serrated adenoma detection rate (risk ratio 1.36, 0.72-2.59), cecal intubation rate (risk ratio 0.99, 0.98-1.00), and time to reach cecum (6.87 min versus 6.87 min) were similar between the two groups. No serious adverse event was observed.
Endocuff-assisted colonoscopy seems to provide a higher adenoma detection rate as compared to cap-assisted colonoscopy, in particular concerning smaller diminutive polyps.
已研发出多种辅助装置以提高结肠腺瘤的检出率。我们旨在通过对随机试验的成对荟萃分析，比较内套辅助结肠镜检查与帽辅助结肠镜检查。
我们检索了截至2020年3月的PubMed/Medline和Embase数据库，确定了6项随机对照试验（共2027例患者）。主要结局为腺瘤检出率；次要结局包括无蒂锯齿状腺瘤检出率、每次结肠镜检查的平均腺瘤数、盲肠插管率及到达盲肠的时间。还分析了安全性数据。我们通过随机效应模型进行成对荟萃分析，并将数据表示为风险比和95%置信区间。
总体而言，内套辅助结肠镜检查的腺瘤合并检出率为48.1%（39.3 - 56.8%），帽辅助结肠镜检查为40.5%（30.4 - 50.6%；风险比1.14，0.96 - 1.35）。内套辅助和帽辅助结肠镜检查的近端腺瘤检出率分别为45.7%（36.8 - 54.7%）和24%（17 - 45.1%）（风险比2.04，0.93 - 4.49），而在内套辅助结肠镜检查在检测微小（≤5mm）腺瘤方面优于帽辅助结肠镜检查（风险比2.74，1.53 - 4.90），且在每次结肠镜检查的平均腺瘤数方面也更优（平均差值0.31，0.05 - 0.57；p = 0.02）。两组的无蒂锯齿状腺瘤检出率（风险比1.36，0.72 - 2.59）、盲肠插管率（风险比0.99，0.98 - 1.00）及到达盲肠的时间（6.87分钟对6.87分钟）相似。未观察到严重不良事件。
与帽辅助结肠镜检查相比，内套辅助结肠镜检查似乎能提供更高的腺瘤检出率，尤其是对于较小的微小息肉。
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