Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicentre randomised controlled trial
| Autor: | Kmaj Tytgat, Pmm Bossuyt, M.W. Mundt, R.C. Mallant-Hent, Pcf Stokkers, Lmg Moons, Gmp Houben, Peter D. Siersema, Actm Depla, H Tuynman, M van der Vlugt, E. Dekker, S.C. van Doorn, Paul Fockens, C. A. Wientjes, Sjoerd D. Kuiken |
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| Přispěvatelé: | Other departments, Gastroenterology and Hepatology, Graduate School, CCA - Imaging and biomarkers, APH - Personalized Medicine, APH - Methodology, Epidemiology and Data Science, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, APH - Quality of Care |
| Rok vydání: | 2017 |
| Předmět: |
Adenoma
Male medicine.medical_specialty Colorectal cancer medicine.medical_treatment Colonoscopy Gastroenterology law.invention Feces Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine Humans Medicine Intubation Conventional colonoscopy Trial registration Aged Academic Medical Centers medicine.diagnostic_test business.industry Immunochemistry Middle Aged medicine.disease Endoscopy 030220 oncology & carcinogenesis Colonic Neoplasms Female 030211 gastroenterology & hepatology Clinical Competence business |
| Zdroj: | Gut, 66, 438-445 Gut, 66, 3, pp. 438-445 Gut, 66(3), 438-445. BMJ Publishing Group Europe PubMed Central |
| ISSN: | 0017-5749 |
| DOI: | 10.1136/gutjnl-2015-310097 |
| Popis: | Background and aimsColonoscopy 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).MethodsWe 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.FindingsOf 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%; pInterpretationThough 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.Trial registration numberhttp://www.trialregister.nlDutch Trial Register: NTR3962. |
| Databáze: | OpenAIRE |
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