title: Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicentre randomised controlled trial.
abstract: Colonoscopy is the current reference standard for the detection of colorectal neoplasia, but nevertheless adenomas remain undetected. The Endocuff, an endoscopic cap with plastic projections, may improve colonic visualisation and adenoma detection. The aim of this study was to compare the mean number of adenomas per patient (MAP) and the adenoma detection rate (ADR) between Endocuff-assisted colonoscopy (EAC) and conventional colonoscopy (CC).
  
  
  
  We performed a multicentre, randomised controlled trial in five hospitals and included fecal immonochemical test (FIT)-positive screening participants as well as symptomatic patients (>45 years). Consenting patients were randomised 1:1 to EAC or CC. All colonoscopies were performed by experienced colonoscopists (≥500 colonoscopies) who were trained in EAC. All colonoscopy quality indicators were prospectively recorded.
  
  
  
  Of the 1063 included patients (52% male, median age 65 years), 530 were allocated to EAC and 533 to CC. More adenomas were detected with EAC, 722 vs 621, but the gain in MAP was not significant: on average 1.36 per patient in the EAC group versus 1.17 in the CC group (p=0.08). In a per-protocol analysis, the gain was 1.44 vs 1.19 (p=0.02), respectively. In the EAC group, 275 patients (52%) had one or more adenomas detected versus 278 in the CC group (52%; p=0.92). For advanced adenomas these numbers were 109 (21%) vs 117 (22%). The adjusted caecal intubation rate was lower with EAC (94% vs 99%; p<0.001), however when allowing crossover from EAC to CC, they were similar in both groups (98% vs 99%; p value=0.25).
  
  
  
  Though more adenomas are detected with EAC, the routine use of Endocuff does not translate in a higher number of patients with one or more adenomas detected. Whether increased detection ultimately results in a lower rate of interval carcinomas is not yet known.
  
  
  
  http://www.trialregister.nl Dutch Trial Register: NTR3962.
authors.affiliation: Departments of Gastroenterology & Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: van Doorn
authors.affiliation: Departments of Gastroenterology & Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van der Vlugt
authors.affiliation: Departments of Gastroenterology & Hepatology, Slotervaartziekenhuis, Amsterdam, The Netherlands.
authors.forename: Actm
authors.initials: A
authors.lastname: Depla
authors.affiliation: Departments of Gastroenterology & Hepatology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Wientjes
authors.affiliation: Departments of Gastroenterology & Hepatology, Flevoziekenhuis, Almere, The Netherlands.
authors.forename: R C
authors.initials: RC
authors.lastname: Mallant-Hent
authors.affiliation: Departments of Gastroenterology & Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.forename: Kmaj
authors.initials: K
authors.lastname: Tytgat
authors.affiliation: Departments of Gastroenterology & Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.|Departments of Gastroenterology & Hepatology, Slotervaartziekenhuis, Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Tuynman
authors.affiliation: Departments of Gastroenterology & Hepatology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: S D
authors.initials: SD
authors.lastname: Kuiken
authors.affiliation: Departments of Gastroenterology & Hepatology, Slotervaartziekenhuis, Amsterdam, The Netherlands.
authors.forename: Gmp
authors.initials: G
authors.lastname: Houben
authors.affiliation: Departments of Gastroenterology & Hepatology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Pcf
authors.initials: P
authors.lastname: Stokkers
authors.affiliation: Departments of Gastroenterology & Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Lmg
authors.initials: L
authors.lastname: Moons
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Pmm
authors.initials: P
authors.lastname: Bossuyt
authors.affiliation: Departments of Gastroenterology & Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Fockens
authors.affiliation: Departments of Gastroenterology & Hepatology, Flevoziekenhuis, Almere, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Mundt
authors.affiliation: Departments of Gastroenterology & Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Dekker
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000009:adverse effects / Q000295:instrumentation*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007120:Immunochemistry; D008297:Male; D008875:Middle Aged
keywords: COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER; POLYP