Post written by Harsh K. Patel, MBBS, and Viveksandeep Thoguluva Chandrasekar, MD, from the Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, and the Department of Gastroenterology, University of Kansas Hospital, Kansas City, Kansas, USA.

The focus of our study was to compare the outcomes of standard high-definition white-light colonoscopy (SC) to second generation cuff-assisted colonoscopy (CC) by performing a systematic review and meta-analysis of published randomized clinical trials (RCTs).

Adenoma detection rate (ADR) is a benchmark and a quality metric in colonoscopy. It has been shown to be inversely associated with the risk of interval colorectal cancer. It can be improved by techniques or devices that improve mucosal exposure or by tools that highlight flat colonic lesions like the distal attachment cuff devices. The second-generation cuff device (CC, Endocuff Vision-EV, Olympus America, Center Valley, PA, USA) was designed to be less bulky with only 1 row of longer and softer flexible arms compared to the first-generation cuff device (Endocuff, Arc Medical Design, Leeds, UK). Existing evidence comparing CC with SC has shown divergent results. Our study was designed to address 3 important questions to better understand where CC fits in routine practice using only randomized studies: 1) Does second generation CC improve colonoscopy polyp metrics compared to SC? 2) What patient population should it be used for? 3) Which endoscopist will derive the most benefit?

The meta-analysis of 8 RCTs demonstrate a 4.2% increase in adenoma detection rate, a 5.1% increase in polyp detection rate, and a 0.13 increase in mean adenomas per colonoscopy along with an approximate 1-minute shorter withdrawal time with CC compared to SC (P < 0.05 for all). In the screening/surveillance population and after excluding FOBT+ patients, the difference in ADR using CC was even higher (6.5% and 7.5%, respectively) compared to SC. The stratification of ADR results based on baseline ADR of the endoscopists demonstrated that endoscopists in the lower ADR groups (< 30%) were associated with the highest benefit in ADR and lowest NNT (11) when using CC. Our study results emphasize the importance of increased mucosal area exposure using distal attachment devices, especially second-generation cuff devices (EV), to enhance polyp detection and other quality metrics especially in low detectors. Further randomized studies are needed to clarify the role of distal attachment cuff devices in routine practice based on screening/surveillance colonoscopy, polyp size, and cost-effectiveness.

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