Endocuff vision vs. standard colonoscopy in the FOBT based UK Bowel cancer screening programme (E-­‐cap study): a randomized trial

Background and Aims - Up to 25% colorectal adenomas are missed during colonoscopy. Our aim was to see if the EndocuffTM vision could improve polyp detection in an organised bowel cancer screening programme (BCSP).

Methods - Parallel group, single blinded, randomised controlled trial. FOBT positive patients who were attending for BCSP colonoscopy were eligible for inclusion. The primary outcome was the number of polyps per patient. Secondary outcomes included the number of adenomas per patient, adenoma and polyp detection rates and withdrawal times.

Results - 534 BCSP patients were randomized to endocuff vision (EC) or standard colonoscopy (SC). The mean age was 67 years and the man to woman ratio was 1.8:1. We detected no significant difference in the number of polyps per patient (SC 1.77; EC 1.64; p=0.441), adenomas per patient (SC 1.35; EC 1.26; p=0.536), polyp detection rate (SC 69.8%, EC 70.3%; p= 0.925), adenoma detection rate (SC 63%, EC 60.9%; p= 0.851), advanced adenoma detection rate (SC 18.5%, EC 16.9%; p=0.81) and cancer detection rate (SC 5.7%, EC 5.3%; p= 0.851).The mean withdrawal time was significantly shorter among patients in the EC compared to SC group (16.85 vs. 19.47 minutes; p<0.005). The endocuff had to be removed in 17 (6.4%) of patients because of inability to pass through the sigmoid colon.

Conclusions - This study did not find an improved polyp or adenoma detection with endocuff vision assisted colonoscopy in the FOBT positive BCSP population. A shorter withdrawal time with EC may reflect improved views and stability provided by the endocuff vision.