Endocuff-assisted colonoscopy for surveillance of serrated polyposis syndrome: a multicenter randomized controlled trial

Liseth Rivero-Sánchez; Jorge López Vicente; Luis Hernandez Villalba; Ignasi Puig; Coral Arnau-Collell; Lorena Moreno; Mireia Díaz; Cristina Rodriguez de Miguel; Teresa Ocaña; Leticia Moreira; Miriam Cuatrecasas; Sabela Carballal; Ariadna Sánchez; Oswaldo Ortiz; Josep Llach; Francesc Balaguer; María Pellisé; on behalf of the EndoCAR group from the Spanish Gastroenterology Association and the Spanish Society of Digestive Endoscopy

doi:10.1055/a-0925-4956

Endoscopy, Table of Contents

Endoscopy 2019; 51(07): 637-645
DOI: 10.1055/a-0925-4956

Original article

Endocuff-assisted colonoscopy for surveillance of serrated polyposis syndrome: a multicenter randomized controlled trial

Liseth Rivero-Sánchez

¹Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Center for Biomedical Research in the Hepatic and Digestive Diseases Network (CIBERehd), Barcelona, Spain

,

Jorge López Vicente

²Hospital Universitario de Móstoles, Digestive System Service, Móstoles, Spain

,

Luis Hernandez Villalba

³Hospital Santos Reyes, Digestive System Service, Aranda de Duero, Spain

,

Ignasi Puig

⁴Althaia, Xarxa Assistencial Universitària de Manresa, Digestive System Service, Manresa, Spain

,

Coral Arnau-Collell

⁵Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

,

Lorena Moreno

⁵Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

,

Mireia Díaz

⁵Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

,

Cristina Rodriguez de Miguel

⁶Hospital Clinic de Barcelona, Digestive Endoscopy Unit, Barcelona, Spain

,

Teresa Ocaña

⁷Hospital Clinic de Barcelona, Department of Gastroenterology, Barcelona, Spain

,

Leticia Moreira

¹Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Center for Biomedical Research in the Hepatic and Digestive Diseases Network (CIBERehd), Barcelona, Spain

,

Miriam Cuatrecasas

⁸Hospital Clinic de Barcelona, Department of Pathology, Barcelona, Spain

,

Sabela Carballal

¹Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Center for Biomedical Research in the Hepatic and Digestive Diseases Network (CIBERehd), Barcelona, Spain

,

Ariadna Sánchez

¹Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Center for Biomedical Research in the Hepatic and Digestive Diseases Network (CIBERehd), Barcelona, Spain

,

Oswaldo Ortiz

⁷Hospital Clinic de Barcelona, Department of Gastroenterology, Barcelona, Spain

,

Josep Llach

⁶Hospital Clinic de Barcelona, Digestive Endoscopy Unit, Barcelona, Spain

,

Francesc Balaguer

¹Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Center for Biomedical Research in the Hepatic and Digestive Diseases Network (CIBERehd), Barcelona, Spain

,

María Pellisé

¹Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Center for Biomedical Research in the Hepatic and Digestive Diseases Network (CIBERehd), Barcelona, Spain

,

on behalf of the EndoCAR group from the Spanish Gastroenterology Association and the Spanish Society of Digestive Endoscopy

› Author Affiliations

Abstract

Background and study aims Serrated polyposis syndrome (SPS) is a condition with high risk for colorectal cancer. The Endocuff device has been shown to increase adenoma detection in the general and screening population. We aimed to ascertain whether Endocuff-assisted colonoscopy increases detection of serrated lesions in comparison with standard colonoscopy during the surveillance of patients with SPS.

Methods In a multicenter randomized controlled study, patients who met SPS criteria I and/or III under surveillance (previous resection of all serrated lesions ≥ 4 mm) were consecutively randomly allocated 1:1 to Endocuff-assisted colonoscopy or standard colonoscopy, performed by expert endoscopists. The main outcome was the mean number of serrated lesions detected per patient.

Results 122 patients (standard colonoscopy n = 60; Endocuff-assisted colonoscopy n = 62; 59 % men; mean age 60.6 (standard deviation [SD] 7.5) were included at 4 centers. Baseline variables (demographic data, SPS phenotype, colorectal cancer [CRC] history, cumulative polyps, and follow-up), cecal intubation rate, and withdrawal time were similar between groups. There was no statistically significant difference between Endocuff-assisted colonoscopy and standard colonoscopy for the mean number of serrated lesions detected per patient: 5.8 (95 % confidence interval [95 %CI] 4.4 – 7.2) and 5.0 (3.9 – 6.1), respectively (P = 0.36). There were also no differences between Endocuff-assisted and standard colonoscopy for detection of sessile serrated lesions (mean number per patient 2.5 [1.3 – 3.6] vs. 2.0 [1.1 – 3.0], P = 0.54) and adenomas (0.9 [0.5 – 1.3] vs. 0.5 [0.3 – 0.7], P = 0.12).

Conclusion Use of Endocuff-assisted colonoscopy did not significantly increase the number of serrated lesion detected per patient during surveillance of SPS.

Full Text

References

References
1 Bosman F, Carneiro F, Hruban RH. World Health Organization. World Health Organization classification of tumours of the digestive system. Lyon: IARC; 2010 4th. edn.
2 Carballal S, Rodríguez-Alcalde D, Moreira L. et al. Colorectal cancer risk factors in patients with serrated polyposis syndrome: a large multicentre study. Gut 2016; 65: 1829-1837
3 IJspeert JEG, Rana SAQ, Atkinson NSS. et al. Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome: a multicentre cohort analysis. Gut 2017; 66: 278-284
4 Rodríguez-Alcalde D, Carballal S, Moreira L. et al. High incidence of advanced colorectal neoplasia during endoscopic surveillance in serrated polyposis syndrome. Endoscopy 2019; 51: 142-151
5 Boparai KS, Mathus-Vliegen EMH, Koornstra JJ. et al. Increased colorectal cancer risk during follow-up in patients with hyperplastic polyposis syndrome: a multicentre cohort study. Gut 2010; 59: 1094-1100
6 Hazewinkel Y, López-Cerón M, East JE. et al. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc 2013; 77: 916-924
7 Hazewinkel Y, de Wijkerslooth TR, Stoop EM. et al. Prevalence of serrated polyps and association with synchronous advanced neoplasia in screening colonoscopy. Endoscopy 2014; 46: 219-224
8 Kahi CJ, Li X, Eckert GJ. et al. High colonoscopic prevalence of proximal colon serrated polyps in average-risk men and women. Gastrointest Endosc 2012; 75: 515-520
9 Moreira L, Pellisé M, Carballal S. et al. High prevalence of serrated polyposis syndrome in FIT-based colorectal cancer screening programmes. Gut 2013; 62: 476-477
10 Biswas S, Ellis AJ, Guy R. et al. High prevalence of hyperplastic polyposis syndrome (serrated polyposis) in the NHS bowel cancer screening programme. Gut 2013; 62: 475
11 Rivero-Sanchez L, Lopez-Ceron M, Carballal S. et al. Reassessment colonoscopy to diagnose serrated polyposis syndrome in a colorectal cancer screening population. Endoscopy 2017; 49: 44-53
12 Vemulapalli KC, Rex DK. Failure to recognize serrated polyposis syndrome in a cohort with large sessile colorectal polyps. Gastrointest Endosc 2012; 75: 1206-1210
13 Gkolfakis P, Tziatzios G, Dimitriadis GD. et al. New endoscopes and add-on devices to improve colonoscopy performance. World J Gastroenterol 2017; 23: 3784
14 Williet N, Tournier Q, Vernet C. et al. Effect of Endocuff-assisted colonoscopy on adenoma detection rate: meta-analysis of randomized controlled trials. Endoscopy 2018; 50: 846-860
15 Castaneda D, Popov VB, Verheyen E. et al. New technologies improve adenoma detection rate, adenoma miss rate, and polyp detection rate: a systematic review and meta-analysis. Gastrointest Endosc 2018; 88: 209-222.e11
16 Facciorusso A, Del Prete V, Buccino RV. et al. Comparative efficacy of colonoscope distal attachment devices in increasing rates of adenoma detection: a network meta-analysis. Clin Gastroenterol Hepatol 2018; 16: 1209-1219.e9
17 Ngu WS, Bevan R, Tsiamoulos ZP. et al. Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial. Gut 2019; 68: 280-288
18 Rex DK, Repici A, Gross SA. et al. High-definition colonoscopy versus Endocuff versus EndoRings versus full-spectrum endoscopy for adenoma detection at colonoscopy: a multicenter randomized trial. Gastrointest Endosc 2018; 88: 335-344.e2
19 Triantafyllou K, Polymeros D, Apostolopoulos P. et al. Endocuff-assisted colonoscopy is associated with a lower adenoma miss rate: a multicenter randomized tandem study. Endoscopy 49: 1051-1060
20 van Doorn SC, van der Vlugt M, Depla AC. Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicenter randomised controlled trial. Gut 2017; 66: 438-445
21 Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 42: 1-10
22 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc 2003; 58 (Suppl. 06) S3-43
23 Kudo S, Hirota S, Nakajima T. et al. Colorectal tumours and pit pattern. J Clin Pathol 1994; 47: 880-885
24 Hayashi N, Tanaka S, Hewett DG. et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78: 625-632
25 von Karsa L, Patnick J, Segnan N. et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45: 51-59
26 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
27 Chilton A, Rutter M. , editors. Quality assurance guidelines for colonoscopy. NHS BCSP Publication No 6. NHS Cancer Screening Programmes. 2011 Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/427591/nhsbcsp06.pdf
28 Marmo C, Napolitano V, Fei L. et al. Mucosal flattening assisted colonoscopy (FAC) to improve the adenoma detection rate: a systematic review and meta-analysis. Endoscopy 2018; 50: S16
29 Kahi CJ, Hewett DG, Norton DL. et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
30 Crockett SD, Gourevitch RA, Morris M. et al. Endoscopist factors that influence serrated polyp detection: a multicenter study. Endoscopy 2018; 50: 984-992
31 López-Vicente J, Rodríguez-Alcalde D, Hernández L. et al. Panchromoendoscopy increases detection of polyps in patients with serrated polyposis syndrome. Clin Gastroenterol Hepatol 2018;
32 Wong NACS, Hunt LP, Novelli MR. et al. Observer agreement in the diagnosis of serrated polyps of the large bowel. Histopathology 2009; 55: 63-66

Supplementary Material

Supplementary material