This study investigates the Compared Meaning of using distal attachments—specifically cuffs and caps—in colonoscopy versus the standard high-definition white light endoscopy (HDWLE) for improving adenoma detection rate (ADR). The core question explored is whether these devices, designed to enhance mucosal visualization, truly offer a significant advantage over conventional methods. Understanding the compared meaning of different colonoscopy techniques is crucial for optimizing patient outcomes and guiding clinical practice.
This prospective, multi-center randomized controlled trial directly compared HDWLE to two types of distal attachments: the cuff (CF) (Endocuff Vision) and the cap (CP) (Reveal). Patients undergoing routine screening or surveillance colonoscopies were enrolled and randomized to one of the three groups. The primary outcome measured was ADR, the rate at which adenomas, which are precancerous polyps, are detected. Secondary outcomes provided further insight into the compared meaning of these techniques, including adenomas per colonoscopy, detection rates of advanced adenomas and sessile serrated lesions, right-sided ADR, withdrawal time, and any adverse events encountered. Statistical analysis was performed using standard methods, with a P value of less than 0.05 considered statistically significant.
The study included 1203 participants, carefully divided into the HDWLE group (n = 384), the CF group (n = 379), and the CP group (n = 379). Baseline characteristics such as age and sex were similar across all groups, ensuring a fair basis for comparison. The results indicated no statistically significant differences in the primary outcome, ADR, across the three groups (HDWLE: 57.3%, CF: 59.1%, CP: 55.7%; P = .6). Similarly, no significant differences were observed in adenomas per colonoscopy, advanced adenoma detection rate, sessile serrated lesion detection rate, or right-sided ADR. However, a notable finding emerged in the number of polyps detected per colonoscopy, which was significantly higher in the CF group (2.7 ± 3.4) when compared to both the HDWLE (2.3 ± 2.5) and CP groups (2.2 ± 2.3; P = .013). Multivariable analysis, adjusting for potential confounding factors, confirmed that device type did not significantly impact the primary outcome of ADR (P = .77). Interestingly, in the subgroup of screening patients, the CF device was associated with a higher number of neoplasms per colonoscopy (CF: 1.7 ± 2.6, HDWLE: 1.3 ± 1.7, CP: 1.2 ± 1.8; P = .047) and a shorter withdrawal time.
In conclusion, the compared meaning of these findings suggests that, for experienced endoscopists, neither cuff nor cap distal attachments provide a significant overall benefit in ADR compared to standard HDWLE. This randomized controlled trial demonstrates that in general practice, the added complexity and cost of these devices may not translate to improved adenoma detection. However, the potential advantage of the Endocuff in screening populations warrants further investigation. These results emphasize the importance of rigorous comparison studies in evaluating medical technologies and refining clinical practices. This trial is registered at ClinicalTrials.gov (NCT03952611).
