Comparison of newer colonoscopy devices with standard forward viewing (SFV) high definition colonoscopies in daily practice

Abstract

Introduction: For years efforts have been made to improve the quality of colonoscopy. Cap assisted colonoscopy has been shown in some studies to increase the adenoma detection rate (ADR). Full‐spectrum colonoscopes (FUSE) with 330°angle of view showed by initial studies a significantly lower adenoma missrate and higher ADR. Our practice‐based, randomized study compares the efficiency of the relatively inexpensive cap assisted, the FUSE or SFV colonoscopy. Method: From March 2015 through February 2018 patients referred for ambulant colonoscopy were randomly allocated to either colonoscopy with high definition SFV Pentax i10 (n=958) or FUSE instruments (n=1552). The group of patients assigned to SFV endoscopy was since March 2017 examined with the additional use of Endocuff, making up another 339 patients. All procedures were performed by one experienced endoscopist. Results: Baseline characteristics of the 2849 patients were similar within the three groups. Mean age was 64 (CI 63‐66), BBPS score 7.23 (CI 7.2‐7.3). Ileum intubation rate was 99% in all groups. With multivariate analysis male sex, diabetes and age were significant risk factors for more adenomas. Better bowel cleansing was also significantly associated with higher adenoma detection. ADR was 50% for FUSE, 54% for SFV and 47% for Endocuff (ns). Adenoma per colonoscopy (APC) were 1.1 in FUSE vs 1.2 in SFV vs 1 with Endocuff (ns). Time to ileum was 5.4 (FUSE), 5.5 (SFV) and 6.3 min (Endocuff); withdrawal time 16.3, 18.1 and 14.1 respectively (p =0.04). Conclusion: Neither FUSE nor Endocuff could increase the ADR in a significant way. Key factor for a high ADR seems to be long withdrawal times. FUSE and Endocuff show significant shorter endoscopy times, Endocuff even significantly less medication for sedation.