Manti Magdalini, Tziatzios Georgios, Facciorusso Antonio, Papaefthymiou Apostolis, Ramai Daryl, Papanikolaou Ioannis, Hassan Cesare, Triantafyllou Konstantinos, Paraskeva Konstantina, Gkolfakis Paraskevas
Department of Gastroenterology, "Konstantopoulio Patision" General Hospital of Nea Ionia, Athens, Greece (Magdalini Manti, Georgios Tziatzios, Konstantina Paraskeva, Paraskevas Gkolfakis).
Department of Medical and Surgical Sciences, University of Foggia, Italy (Antonio Facciorusso).
Ann Gastroenterol. 2023 Sep-Oct;36(5):533-540. doi: 10.20524/aog.2023.0820. Epub 2023 Jul 3.
Add-on devices with projections, e.g., Endocuff, Endocuff Vision, EndoRings, and Wingcap, placed on the distal tip of the colonoscope promise to improve the detection of precancerous lesions. We performed a meta-analysis to evaluate the performance of these devices exclusively among individuals undergoing colonoscopy for screening purpose.
A computerized literature search was performed across MEDLINE and Cochrane Library databases for randomized controlled trials that compared standard colonoscopy (SC) to procedures using add-on devices. The primary outcome was adenoma detection rate (ADR), while secondary outcomes included polyp detection rate (PDR), advanced ADR (AADR), and sessile serrated lesion detection rate (SSLDR). The effect size on study outcomes was calculated using a random-effects model and presented as the risk ratio (RR) and 95% confidence interval (CI).
Seven studies enrolling a total of 5785 patients were included. The use of add-on-devices with projections was associated with a higher ADR compared to SC: 45.9% vs. 41.1%; RR 1.18, 95%CI 1.02-1.37; P=0.03; =79%. Although PDR was higher in screening colonoscopies assisted by add-on devices as compared to SC, the difference failed to reach significance: 55.1% vs. 50.8%; RR 1.10, 95%CI 0.96-1.26; P=0.17; =75%. No difference was found between procedures assisted by add-on devices with projections and SC colonoscopies in terms of AADR (18.5% vs. 17.6%; RR 1.00, 95%CI 0.79-1.27; P=0.98; =56%) or SSLDR (6.8% vs. 5.8%; RR 1.17, 95%CI 0.95-1.44; P=0.15; =0%).
Colonoscopy assisted by add-on devices with projections achieves a better ADR compared to SC among individuals undergoing screening for bowel cancer.
带有突起的附加装置，如Endocuff、Endocuff Vision、EndoRings和Wingcap，放置在结肠镜远端，有望提高癌前病变的检测率。我们进行了一项荟萃分析，专门评估这些装置在接受结肠镜筛查的个体中的性能。
通过计算机检索MEDLINE和Cochrane图书馆数据库，查找比较标准结肠镜检查（SC）与使用附加装置的检查方法的随机对照试验。主要结局是腺瘤检出率（ADR），次要结局包括息肉检出率（PDR）、高级别腺瘤检出率（AADR）和无蒂锯齿状病变检出率（SSLDR）。使用随机效应模型计算研究结局的效应量，并以风险比（RR）和95%置信区间（CI）表示。
纳入7项研究，共5785例患者。与SC相比，使用带有突起的附加装置与更高的ADR相关：45.9%对41.1%；RR 1.18，95%CI 1.02 - 1.37；P = 0.03；I² = 79%。虽然与SC相比，附加装置辅助的筛查结肠镜检查中PDR更高，但差异未达到显著水平：55.1%对50.8%；RR 1.10，95%CI 0.96 - 1.26；P = 0.17；I² = 75%。在AADR（18.5%对17.6%；RR 1.00，95%CI 0.79 - 1.27；P = 0.98；I² = 56%）或SSLDR（6.8%对5.8%；RR 1.17，95%CI 0.95 - 1.44；P = 0.15；I² = 0%）方面，带有突起的附加装置辅助的检查方法与SC结肠镜检查之间未发现差异。
在接受肠癌筛查的个体中，与SC相比，带有突起的附加装置辅助的结肠镜检查可实现更好的ADR。
