While many different endoscopic aids are available; there is a dearth of information regarding their relative efficacy. Researchers did a systematic review and network meta-analysis to compare the performance of various endoscopic aids for detecting colonic adenomas.
To find randomized controlled trials RCTs and dual-arm observational studies comparing colonoscopy with alternative endoscopic assist devices and/or normal colonoscopy, a comprehensive search was conducted utilizing multiple electronic databases up until July 2020. Adenoma detection rate (ADR) was the primary endpoint. As secondary outcomes, they looked at polyp detection rate (PDR), serrated adenoma detection rate (SADR), right-sided adenoma detection rate (RADR), and proximal adenoma detection rate (PADR).
There were 57 studies totaling 31,051 patients that matched the criteria for inclusion. According to a network meta-analysis, all 3 devices ((clear) cap [odds ratio (OR): 2.69, 95% confidence interval (CI): 1.45-4.99], endocuff, (OR: 4.95, 95% CI: 3.15-7.78), and endoring (OR: 3.68, 95% CI: 1.47-9.20)) improved ADR. When looking at PDR, similar results were observed. Both endocuffing (odds ratio [OR] 9.43) and endoring (OR = 4.06) were found to result in higher SADR compared to conventional colonoscopy. In contrast, only endocuff was found to have increased RADR (OR = 5.36) and PADR (OR = 3.78).
The Endocuff showed the highest ADR, PDR, and SADR in comparison to the other assist devices, however, this was not statistically significant. Cap and endocuff were found to have improved PDR and ADR in a subgroup analysis of randomized controlled trials. When compared to conventional colonoscopy, endoscopic aids showed higher rates of adverse events (ADR) and positive events (PDR) and should be used more frequently. There was a tendency, but not a statistically significant one, toward increased efficacy for the endocuff device.