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Thématique :
- Endoscopie/Imagerie
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Pas encore
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Nom du veilleur :
Docteur Florian ROSTAIN
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Gut
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2016/01
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Dec 16. pii: gutjnl-2015-310097
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doi: 10.1136/gutjnl-2015-310097. [Epub ahead of print]
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Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicentre randomised controlled trial.
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van Doorn SC, van der Vlugt M, Depla A, Wientjes CA, Mallant-Hent RC, Siersema PD, Tytgat K, Tuynman H, Kuiken SD, Houben G, Stokkers P, Moons L, Bossuyt P, Fockens P, Mundt MW, Dekker E
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http://www.ncbi.nlm.nih.gov/pubmed/?term=Adenoma+detection+with+Endocuff+colonoscopy+versus+conventional+colonoscopy%3A+a+multicentre+randomised+controlled+trial.
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BACKGROUND AND AIMS:
Colonoscopy is the current reference standard for the detection of colorectal neoplasia, but nevertheless adenomas remain undetected. The Endocuff, an endoscopic cap with plastic projections, may improve colonic visualisation and adenoma detection. The aim of this study was to compare the mean number of adenomas per patient (MAP) and the adenoma detection rate (ADR) between Endocuff-assisted colonoscopy (EAC) and conventional colonoscopy (CC).
METHODS:
We performed a multicentre, randomised controlled trial in five hospitals and included fecal immonochemical test (FIT)-positive screening participants as well as symptomatic patients (>45 years). Consenting patients were randomised 1:1 to EAC or CC. All colonoscopies were performed by experienced colonoscopists (≥500 colonoscopies) who were trained in EAC. All colonoscopy quality indicators were prospectively recorded.
FINDINGS:
Of the 1063 included patients (52% male, median age 65 years), 530 were allocated to EAC and 533 to CC. More adenomas were detected with EAC, 722 vs 621, but the gain in MAP was not significant: on average 1.36 per patient in the EAC group versus 1.17 in the CC group (p=0.08). In a per-protocol analysis, the gain was 1.44 vs 1.19 (p=0.02), respectively. In the EAC group, 275 patients (52%) had one or more adenomas detected versus 278 in the CC group (52%; p=0.92). For advanced adenomas these numbers were 109 (21%) vs 117 (22%). The adjusted caecal intubation rate was lower with EAC (94% vs 99%; p<0.001), however when allowing crossover from EAC to CC, they were similar in both groups (98% vs 99%; p value=0.25).
INTERPRETATION:
Though more adenomas are detected with EAC, the routine use of Endocuff does not translate in a higher number of patients with one or more adenomas detected. Whether increased detection ultimately results in a lower rate of interval carcinomas is not yet known.
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Est-ce que le système Endocuff permet d’augmenter le nombre d’adénomes détectés par patient (MAP) et le taux de détection des adénomes (ADR) par rapport à la coloscopie standard ?
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Étude multicentrique comparative randomisée chez des patients de plus de 45 ans ayant eu un test fécal immunologique positif.
Le nombre d’adénomes détectés par patient n’était pas significativement différent de même que le nombre d’adénomes avancés détectés.
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En 2014 Biecher et al. avaient montré une augmentation du taux de détection de polypes avec le système Endocuff. Cette étude remet en cause son intérêt. D’autres études doivent être réalisées pour déterminer si le système Endocuff augmente le taux de détection de polypes, avancés ou non, et s’il permet un bénéfice clinique.
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