The incidence and mortality rates of colorectal cancer have steadily declined over the past decades in adults age 50 and older, due in part to the dramatic increase in screening across the United States. Equally important have been the ongoing efforts to enhance the quality of screening tests, according to Seth A. Gross, MD, associate professor in the Department of Medicine and director of clinical care and quality in the Division of Gastroenterology and Hepatology at NYU Langone Health.
Trial Targets Exam Time for Complete Mucosal Inspection
As part of this effort, medical professionals are evaluating technological advances to improve detection of polyps and other lesions during colonoscopy. In a recent study, Dr. Gross and colleagues studied cuff-assisted colonoscopy using Endocuff Vision®, a mechanical colonoscopy enhancement. Compared with standard colonoscopy, cuff-assisted colonoscopy showed decreased inspection time without reducing adenoma and sessile serrated polyp detection rates.
To ensure optimal adenoma detection and cancer prevention, viewing polyps and lesions is critical. But they may be hidden by folds along the lining of the colon and rectum. The Endocuff Vision® is a small device that fits on the tip of the colonoscope and features fingerlike extensions that help pull back the folds and increase mucosal exposure.
“This randomized trial was focused on colonoscopy withdrawal times for complete mucosal inspection as the primary endpoint, in addition to measuring detection of polyps,” says Dr. Gross.
The researchers randomly assigned 200 adults over age 40 to receive colorectal cancer screening or surveillance using either the Endocuff-assisted or standard colonoscopy, performed by two experienced endoscopists. Mean inspection time with the cuff-assisted procedure was reduced by 23 percent without impairing lesion detection compared with standard colonoscopy (6.5 versus 8.4 minutes). Also, the adenoma detection rate (61.4 percent versus 52 percent; P = 0.21) and sessile serrated polyp detection rate (19.8 percent versus 11.1 percent; P = 0.09) were higher with the cuff-assisted procedure.
The trial demonstrates that physicians can perform an efficient colonoscopy without compromising colonoscopy exam quality. The learning curve to use Endocuff Vision® is short, since gastroenterologists are proficient in colonoscopy.
“These findings suggest that the cuff device may allow for easier visualization of the mucosa, thereby maintaining adenoma detection rates while decreasing withdrawal time compared with standard colonoscopy methods,” explains Dr. Gross.
Enhanced Visualization, Shorter Inspection Times
Findings from the current study suggest that Endocuff Vision® could potentially achieve the dual goals of improving detection and offering a more efficient colonoscopy. The authors also observe that previous, larger studies have reported that when inspection times are equal, the Endocuff Vision® is better at detecting lesions compared with standard colonoscopy.
“Overall, these findings suggest that technological advances, such as the cuff-assisted colonoscopy, can help us optimize efficiency and increase quality in endoscopy,” says Dr. Gross. “Together with increased screening rates, we hope that a continued focus on quality in screening will result in further innovations and increased numbers of precancerous polyps removed and lives saved.”
Investigators caution that, based on previous studies, a small fraction of patients will require removal of the Endocuff Vision® for safe navigation through the sigmoid colon. Colonoscopy without the device should be considered in patients with known severe sigmoid diverticular disease.
Disclosure: Seth A. Gross, MD, is a consultant to Olympus Corporation.