High definition technology, add-on devices improve colonoscopy output
High-definition, forward-facing colonoscopes better identified adenomas during screening colonoscopy than a full spectrum endoscopy system, according to research published in Gastrointestinal Endoscopy.
Douglas K. Rex, MD, of the Indiana University School of Medicine, and colleagues found that the addition of adjunct devices, such as Endocuff (Arc Medical Design) or EndoRings (US Endoscopy), also improved detection, even among high-level endoscopists.
“In this study we sought to evaluate the utility of mucosal exposure devices in the hands of colonoscopists with known high [adenoma detection rates] when using standard equipment,” they wrote. “In addition, we sought to directly compare three mucosal exposure devices with each other, namely Endocuff versus EndoRings versus [full spectrum endoscopy].”
In a three-center, prospective trial, Rex and colleagues randomly assigned 1,188 patients into one of four study groups; HD forward-viewing colonoscopy alone (n = 295), HD with Endocuff (n = 299), HD with EndoRings (n = 295), and the full spectrum endoscopy system (FUSE; Endochoice, n = 299). All patients were aged at least 50 years and had routine indications, as well as intact colons. The endoscopists who performed the screenings all had a proven baseline ADR of at least 40%, and the primary endpoint was adenomas per colonoscopy (APC).
The Endocuff produced the highest mean APC (APC mean ± standard deviation: 1.82 ± 2.58), followed by EndoRings (1.55 ± 2.42), HD colonoscopy (1.53 ± 2.33) and the FUSE system (1.3 ± 1.96). Endocuff also produced the highest ADR (64%), followed by EndoRings (57%), HD colonoscopy (56%) and the FUSE system (52%).
Rex and colleagues wrote that their findings indicate that for high-level detectors, image resolution outweighs angle of view when it comes to adenoma detection. However, the addition of an adjunct mucosal exposure device, particularly the Endocuff, improves APC and ADR, even among skilled users.
“Use of an adjunct on the end of an HD forward-viewing colonoscope produced gains in adenoma detection even in the hands of examiners who are very skilled with standard instruments lacking adjunctive devices.,” they wrote. – by Alex Young
Disclosures: Rex reports financial ties to Boston Scientific, Medivators, EndoChoice, EndoAid, Braintree Laboratories, Medtronics, Colonary Solutions, PAION, US Endoscopy and Olympus. Please see the full study for all other authors’ relevant financial disclosures.