Effect of Endocuff use on colonoscopy outcomes: A systematic review and meta-analysis

BACKGROUND Endocuff - a plastic device with flexible projections - mounted on the distal tip of the colonoscope, promises improved colonic mucosa inspection. AIM To elucidate the effect of Endocuff on adenoma detection rate (ADR), advanced ADR (AADR) and mean number of adenomas per colonoscopy (MAC). METHODS Literature searches identified randomized-controlled trials evaluating Endocuff-assisted colonoscopy (EAC) vs conventional colonoscopy (CC) in terms of ADR, AADR and MAC. The effect size on study outcomes was calculated using fixed or random effect model, as appropriate, and it is shown as relative risk (RR) [95% confidence interval (CI)] and mean difference (MD) (95% CI). The rate of device removal in EAC arms was also calculated. RESULTS We identified nine studies enrolling 6038 patients. All studies included mixed population (screening, surveillance and diagnostic examinations). Seven and two studies evaluated the first and the second-generation device, respectively. EAC was associated with increased ADR compared to CC [RR (95% CI): 1.18 (1.05-1.32);I-2 = 71%]; EAC benefits more endoscopists with ADR <= 35% compared to those with ADR > 35% [RR (95% CI): 1.37 (1.08-1.74);I-2 = 49% vs 1.10 (0.99-1.24);I-2 = 71%]. In terms of AADR and MAC, no difference was detected between EAC and CC [RR (95% CI): 1.03 (0.85-1.25);I-2 = 15% and MD (95% CI): 0.30 (-0.17-0.78);I-2 = 99%]. Subgroup analysis did not show any difference between the two device generations regarding all three endpoints. In EAC arms, the device had to be removed in 3% (95% CI: 2%-5%) of the cases mainly due to tortuous sigmoid or presence of diverticula along it. CONCLUSION EAC increases ADR compared to CC, especially for endoscopists with lower ADR. On the other hand, no significant effect on AADR and MAC was detected.