Which endoscopic tool is best at detecting colonic adenoma, polyp?

Use of endoscopic assist devices to find any signs of colonic adenoma results in better adenoma detection rate (ADR) and polyp detection rate (PDR) when compared with standard colonoscopy, reports a study, adding that these devices should be widely adopted.

In addition, a nonsignificant trend toward higher efficacy for the Endocuff device has been observed.

“Numerous endoscopic assist devices exist, yet data surrounding their comparative efficacy is lacking,” said the researchers, who then set out to perform a systematic review with network meta-analysis to determine the comparative efficacy of endoscopic assist devices on colonic adenoma detection.

Using multiple electronic databases, they conducted a systematic search through July 2020 to identify randomized controlled trials and dual-arm observational studies comparing endoscopic assist devices with other tools and/or with standard colonoscopy. ADR was the primary outcome, while secondary ones included PDR, serrated ADR, right-sided ADR, and proximal ADR.

Fifty-seven studies, including a total of 31,051 patients, met the eligibility criteria. Network meta-analysis revealed an increased ADR with the following endoscopic assist devices: (clear) cap (odds ratio [OR], 2.69, 95 percent confidence interval [CI], 1.45‒4.99), Endocuff (OR, 4.95, 95 percent CI, 3.15‒7.78), and EndoRing (OR, 3.68, 95 percent CI, 1.47‒9.20). [J Clin Gastroenterol 2022;56:889-894]

No significant differences were seen among these devices, and findings for PDR were similar.

Compared with standard colonoscopy, Endocuff (OR, 9.43) and EndoRing (OR, 4.06) showed improved serrated ADR, whereas only Endocuff demonstrated improved right-sided (OR, 5.36) and proximal ADRs (OR, 3.78). Although Endocuff delivered the highest ADR, proximal ADR, and serrated ADR, it did not achieve significance when compared with other devices.

In a subgroup analysis of randomized controlled trials, both cap and Endocuff demonstrated increased ADR and PDR.

However, another network meta-analysis revealed that water exchange was superior to Endocuff and cap colonoscopy at detecting sessile serrated adenoma/polyp (SSA/P) and that it significantly enhanced serrated ADR and PDR. [J Gastroenterol Hepatol 2021;36:3268-3277]

In this study, the investigators conducted a network meta-analysis with random effect models comparing serrated ADR and PDR of each method, with air insufflation as the control. A total of 531 articles were identified, of which 11 were included in the analysis.

Water exchange significantly enhanced serrated ADR and PDR (OR, 2.04, 95 percent CI, 1.33‒3.13), while Endocuff (OR, 1.15, 95 percent CI, 0.94‒1.41) and cap (OR, 1.08, 95 percent CI, 0.42‒2.72) did not substantially improve SSA/P detection.

Results indicated that water exchange (p=0.96) had the highest serrated ADR and PDR compared with Endocuff (p=0.49), cap (p=0.37), and air insufflation (p=0.17). These findings persisted even after adjusting for mean withdrawal time and indication for colonoscopy.

“SSA/P may contribute to interval cancer,” the investigators said. In a recent meta-analysis, water exchange was shown to be superior to Endocuff and cap colonoscopy at adenoma and advanced adenoma detection.”