Aziz Muhammad, Haghbin Hossein, Gangwani Manesh Kumar, Sharma Sachit, Nawras Yusuf, Khan Zubair, Chandan Saurabh, Mohan Babu P, Lee-Smith Wade, Nawras Ali
Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States.
Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States.
Endosc Int Open. 2021 Jan;9(1):E41-E50. doi: 10.1055/a-1293-7327. Epub 2021 Jan 1.
Recently, the newer Endocuff Vision (ECV) has been evaluated for improving colonoscopy outcome metrics such as adenoma detection rate (ADR) and polyp detection rate (PDR). Due to lack of direct comparative studies between ECV and original Endocuff (ECU), we performed a systematic review and network meta-analysis to evaluate these outcomes. The following databases were searched: PubMed, Embase, Cochrane, and Web of Sciences to include randomized controlled trials (RCTs) comparing ECV or ECU colonoscopy to high-definition (HD) colonoscopy. Direct as well as network meta-analyses comparing ADR and PDR were performed using a random effects model. Relative-risk (RR) with 95 % confidence interval (CI) was calculated. A total of 12 RCTs with 8638 patients were included in the final analysis. On direct meta-analysis, ECV did not demonstrate statistically improved ADR compared to HD colonoscopy (RR: 1.12, 95 % CI 0.99-1.27). A clinically and statistically improved PDR was noted for ECV compared to HD (RR: 1.15, 95 % CI 1.03-1.28) and ECU compared to HD (RR: 1.26, 95 % CI 1.09-1.46) as well as improved ADR (RR: 1.22, 95 % CI 1.05-1.43) was observed for ECU colonoscopy when compared to HD colonoscopy. These results were also consistent on network meta-analysis. Lower overall complication rates (RR: 0.14, 95 % CI 0.02-0.84) and particularly lacerations/erosions (RR: 0.11, 95 % CI 0.02-0.70) were noted with ECV compared to ECU colonoscopy. Although safe, the newer ECV did not significantly improve ADR compared to ECU and HD colonoscopy. Further device modification is needed to increase the overall ADR and PDR.
最近，新型的Endocuff Vision（ECV）已被评估用于改善结肠镜检查的结果指标，如腺瘤检出率（ADR）和息肉检出率（PDR）。由于缺乏ECV与原始Endocuff（ECU）之间的直接对比研究，我们进行了一项系统评价和网状Meta分析来评估这些结果。我们检索了以下数据库：PubMed、Embase、Cochrane和Web of Sciences，以纳入比较ECV或ECU结肠镜检查与高清（HD）结肠镜检查的随机对照试验（RCT）。使用随机效应模型进行了比较ADR和PDR的直接以及网状Meta分析。计算了具有95%置信区间（CI）的相对风险（RR）。最终分析共纳入了12项RCT，涉及8638例患者。在直接Meta分析中，与HD结肠镜检查相比，ECV的ADR在统计学上并未显示出改善（RR：1.12，95%CI 0.99 - 1.27）。与HD相比，ECV的PDR在临床和统计学上有改善（RR：1.15，95%CI 1.03 - 1.28），与HD相比，ECU的PDR也有改善（RR：1.26，95%CI 1.09 - 1.46），并且与HD结肠镜检查相比，ECU结肠镜检查的ADR也有改善（RR：1.22，95%CI 1.05 - 1.43）。这些结果在网状Meta分析中也一致。与ECU结肠镜检查相比，ECV的总体并发症发生率较低（RR：0.14，95%CI 0.02 - 0.84），尤其是撕裂伤/糜烂（RR：0.11，95%CI 0.02 - 0.70）。虽然安全，但与ECU和HD结肠镜检查相比，新型ECV并未显著提高ADR。需要进一步改进设备以提高总体ADR和PDR。
