title: Endocuff-assisted colonoscopy increases polyp detection rate: a simulated randomized study involving an anatomic colorectal model and 32 international endoscopists.
abstract: BACKGROUND
  The undetected colonic lesions behind the folds and flexures are a major factor contributing to the adenoma miss rate.
  
  
  OBJECTIVE
  To assess the efficacy of Endocuff, a special attachment was fixed at the distal tip of a colonoscope, for the polyp detection. This soft accessory is composed of a plastic cap surrounded by flexible finger-like projections on the lateral sides of the cap that make holding of the folds during scope withdrawal easier.
  
  
  METHODS
  This was a simulated pilot study with one anatomic colorectal model, containing 13 polyps positioned in obvious locations and behind the folds. Thirty-two endoscopists (16 Japanese and 16 foreign visitors) with different levels of experience performed examinations on the model in a randomized order by using Endocuff-assisted colonoscopy (EAC) and standard colonoscope (SC).
  
  
  METHODS
  To assess the detection rate of polyps and the feasibility of Endocuff insertion.
  
  
  RESULTS
  EAC detected significantly more polyps than SC with 9.9 versus 7.5 mean lesions (p = 0.03), respectively, comparing the 16 first colonoscopies in each group. Endocuff was useful independent of the level of experience of the participants. After crossover, EAC in second position allowed an additional detection of 1.8 polyps compared with SC (p = 0.001). After adjustment on experience, time of detection, and order of colonoscopy, EAC over-detected 1.2 polyps (p = 0.0037). The insertion time (p = 0.99) was identical. There was no difference in the mean time of polyp detection between EAC and SC groups (p = 0.520).
  
  
  CONCLUSIONS
  This was not a clinical study. The stiffness of the folds in the colonic model was higher than in the human large bowel.
  
  
  CONCLUSIONS
  EAC was associated with a higher polyp detection rate. Even in such relatively stiff anatomic model, it was easier to spread out the colonic mucosa between the folds using this cap. This study provides an additional argument for the routine application of this easy-to-use accessory to improve polyp detection.
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan. mathieupioche@free.fr.|Endoscopy Division, Edouard Herriot Hospital, Lyon, France. mathieupioche@free.fr.
authors: Mathieu
authors: M
authors: Pioche
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
authors: Minori
authors: M
authors: Matsumoto
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
authors: Hiroyuki
authors: H
authors: Takamaru
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
authors: Taku
authors: T
authors: Sakamoto
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
authors: Takeshi
authors: T
authors: Nakajima
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
authors: Takahisa
authors: T
authors: Matsuda
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
authors: Seiichiro
authors: S
authors: Abe
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
authors: Yasuo
authors: Y
authors: Kakugawa
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
authors: Yosuke
authors: Y
authors: Otake
authors: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan. ytsaito@ncc.go.jp.
authors: Yutaka
authors: Y
authors: Saito
mesh_terms: D000328:Adult; D003111:Colonic Polyps / Q000175:diagnosis* / Q000601:surgery; D020685:Colonoscopes; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D010865:Pilot Projects; D011446:Prospective Studies; D011897:Random Allocation
keywords: Colorectal cancer; General endoscopy; Training endoscopy