title: Higher adenoma detection rates with endocuff-assisted colonoscopy - a randomized controlled multicenter trial.
abstract: OBJECTIVE
  The Endocuff is a device mounted on the tip of the colonoscope to help flatten the colonic folds during withdrawal. This study aimed to compare the adenoma detection rates between Endocuff-assisted (EC) colonoscopy and standard colonoscopy (SC).
  
  
  METHODS
  This randomized prospective multicenter trial was conducted at four academic endoscopy units in Germany.
  
  
  METHODS
  500 patients (235 males, median age 64[IQR 54-73]) for colon adenoma detection purposes were included in the study. All patients were either allocated to EC or SC. The primary outcome measure was the determination of the adenoma detection rates (ADR).
  
  
  RESULTS
  The ADR significantly increased with the use of the Endocuff compared to standard colonoscopy (35.4%[95% confidence interval{CI} 29-41%] vs. 20.7%[95%CI 15-26%], p<0.0001). Significantly more sessile polyps were detected by EC. Overall procedure time and withdrawal time did not differ. Caecal and ileum intubation rates were similar. No major adverse events occurred in both groups. In multivariate analysis, age (odds ratio [OR] 1.03; 95%[CI] 1.01-1.05), male sex (OR 1.74; 95%CI 1.10-2.73), withdrawal time (OR 1.16; 95%CI 1.05-1.30), procedure time (OR 1.07; 95%CI 1.04-1.10), colon cleanliness (OR 0.60; 95%CI 0.39-0.94) and use of Endocuff (OR 2.09; 95%CI 1.34-3.27) were independent predictors of adenoma detection rates.
  
  
  CONCLUSIONS
  EC increases the adenoma detection rate by 14.7%(95%CI 6.9-22.5%). EC is safe, effective, easy to handle and might reduce colorectal interval carcinomas.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02034929.
authors.affiliation: Departments of Gastroenterology, HELIOS Albert-Schweitzer-Hospital Northeim, Northeim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Floer
authors.affiliation: HELIOS Medical Center Siegburg, Siegburg, Germany; Department of Gastroenterology, Zollernalb Medical Center, Bailingen, Germany.
authors.forename: Erwin
authors.initials: E
authors.lastname: Biecker
authors.affiliation: HELIOS St. Marienberg Hospital Helmstedt, Helmstedt, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Fitzlaff
authors.affiliation: Departments of Gastroenterology, HELIOS Albert-Schweitzer-Hospital Northeim, Northeim, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Röming
authors.affiliation: HELIOS St. Marienberg Hospital Helmstedt, Helmstedt, Germany.
authors.forename: Detlev
authors.initials: D
authors.lastname: Ameis
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Heinecke
authors.affiliation: Department of Gastroenterology II, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Kunsch
authors.affiliation: Department of Gastroenterology II, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Ellenrieder
authors.affiliation: Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ströbel
authors.affiliation: HELIOS Medical Center Siegburg, Siegburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schepke
authors.affiliation: Departments of Gastroenterology, HELIOS Albert-Schweitzer-Hospital Northeim, Northeim, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Meister
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis*; D020685:Colonoscopes; D003113:Colonoscopy; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies