SNFGE SNFGE
 
Thématique :
- Endoscopie - Imagerie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2017/03  
 
  Gut 2017 Mar;66(3):438-445.  
  doi: 10.1136/gutjnl-2015-310097  
 
  Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicentre randomised controlled trial  
 
  SC van Doorn, M van der Vlugt, ACTM Depla, CA Wientjes, RC Mallant-Hent, PD Siersema, KMAJ Tytgat, H Tuynman, SD Kuiken, GMP Houben, PCF Stokkers, LMG Moons, PMM Bossuyt, P Fockens, MW Mundt, E Dekker  
  http://gut.bmj.com/content/early/2015/12/25/gutjnl-2015-310097  
 
 

Abstract

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.

 
 
 
Question posée
 
La coloscopie assistée par Endocuff (capuchon spécifiquement dessiné pour déplisser le colon) est-elle supérieure à la coloscopie conventionnelle ?
 
Question posée
 
Dans cette étude randomisée contrôlée ayant inclus 1063 patients dans 5 hôpitaux néerlandais, le taux d’adénome par patient n’était pas statistiquement différent entre les 2 bras (1,36 adénome par patient dans le bras Endocuff versus 1,17 dans le groupe coloscopie conventionnelle).
 
Commentaires

Cette étude solide suggère l’absence d’intérêt à utiliser l’endocuff. Le coût (non négligeable) du dispositif est également un obstacle à l’utilisation large de ce dispositif. D’autres études sont actuellement en cours. 

 
www.snfge.org