The effect of the endoscopic device Endocuff™/Endocuff Vision™ on quality standards in colonoscopy: a systematic review and meta-analysis of randomised trials.

BACKGROUND AND AIMS
Adenoma detection rate (ADR) is an important quality measure, with high ADR reflecting high-quality colonoscopy. This systematic review and meta-analysis assessed the effects of Endocuff™/Endocuff Vision™- assisted colonoscopy (EAC) versus standard colonoscopy (SC) on ADR and other clinical, patient, and resource-use outcomes.


METHODS
MEDLINE, EMBASE, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials were searched for full papers reporting randomised studies, comparing EAC with SC. The primary outcome was ADR. Secondary outcomes comprised key polyp/adenoma detection, procedure-related, patient-related and health economic measures. Random effects meta-analyses provided pooled estimates of outcomes (risk ratio (RR) or mean difference (MD), with 95% confidence intervals [CI]).


RESULTS
Twelve parallel-group RCTs and three crossover RCTs with data on 9,140 patients were included. EAC significantly increased ADR (RR, 1.18; 95% CI 1.09-1.29), mean adenomas per procedure (MAP) (MD, 0.19; 95% CI 0.06-0.33), polyp detection rate (PDR) (RR, 1.20; 95% CI 1.10-1.30) and mean polyps per procedure (MPP) (MD, 0.39; 95% CI 0.14-0.63) versus SC. EAC significantly increased segmental PDR versus SC in the sigmoid (RR, 2.02; 95% CI 1.64-2.49), transverse (RR, 1.63; 95% CI 1.09-2.42), ascending (RR, 1.74; 95% CI 1.26-2.41) and caecal segments (RR, 1.91; 95% CI 1.29-2.82). Procedure-related variables did not differ between arms. There were insufficient data for meta-analysis of health economic or patient-centred outcomes.


CONCLUSIONS
EAC increased ADR, MAP, PDR and MPP versus SC, without detrimental effects on procedure measures. Cost-effectiveness and patient experience data are lacking and would be valuable to inform practice recommendations.