Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection: A Network Meta-analysis

Antonio Facciorusso, Valentina Del Prete, Rosario Vincenzo Buccino, Nicola Della Valle, Maurizio Cosimo Nacchiero, Fabio Monica, Renato Cannizzaro, Nicola Muscatiello

Research output: Contribution to journalReview article

Abstract

Background & Aims: Several add-on devices have been developed to increase rates of colon adenoma detection (ADR). We assessed their overall and comparative efficacy, and estimated absolute magnitude of benefit through a network meta-analysis. Methods: We searched the PubMed/Medline and Embase database through March 2017 and identified 25 randomized controlled trials (comprising 16,103 patients) that compared the efficacy of add-on devices (cap; Endocuff; Arc Medical Design Ltd, Leeds, UK, and Endorings; Us Endoscopy, Mentor, OH) with each other or with standard colonoscopy. The primary outcome was ADR; secondary outcomes included rate of polyp detection, and rate of and time to cecal intubation. We performed pairwise and network meta-analyses, and appraised quality of evidence using Grading of Recommendations Assessment, Development and Evaluation. We estimated the magnitude of increase in ADR by low-performing endoscopists (baseline ADR, 10%) and high-performing endoscopists (baseline ADR, 40%) with use of these devices. Results: Overall, distal attachment devices increased ADR compared with standard colonoscopy (relative risk [RR], 1.13; 95% CI, 1.03–1.23; low-quality evidence), with potential absolute increases in ADR to 11.3% for low-performing endoscopists and to 45.2% for high-performing endoscopists. In a comparative evaluation, we found low-quality evidence that Endocuff increases ADR compared with standard colonoscopy (RR, 1.21; 95% CI, 1.03–1.41), with anticipated increases in ADR to 12% for low-performing endoscopists and to 48% for high-performing endoscopists. We found very low quality evidence to support the use of Endorings (RR, 1.70; 95% CI, 0.86–3.36) or caps (RR, 1.07; 95% CI, 0.96–1.19) vs standard colonoscopy for increasing ADR. The benefit of one distal attachment device over another was uncertain due to very low quality evidence. Conclusions: Based on network meta-analysis, we anticipate only modest improvement in ADRs with use of distal attachment devices, especially in low-performing endoscopists.

Original languageEnglish
Pages (from-to)1209-1219.e9
JournalClinical Gastroenterology and Hepatology
Volume16
Issue number8
DOIs
Publication statusPublished - Aug 1 2018

Fingerprint

Colonoscopes
Adenoma
Colonoscopy
Equipment and Supplies
Mentors
Polyps
PubMed
Intubation
Endoscopy
Network Meta-Analysis
Colon
Randomized Controlled Trials
Databases

Keywords

  • Cap-Assisted
  • Colon Cancer
  • GRADE
  • Tumor

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Facciorusso, A., Del Prete, V., Buccino, R. V., Della Valle, N., Nacchiero, M. C., Monica, F., ... Muscatiello, N. (2018). Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection: A Network Meta-analysis. Clinical Gastroenterology and Hepatology, 16(8), 1209-1219.e9. https://doi.org/10.1016/j.cgh.2017.11.007

Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection : A Network Meta-analysis. / Facciorusso, Antonio; Del Prete, Valentina; Buccino, Rosario Vincenzo; Della Valle, Nicola; Nacchiero, Maurizio Cosimo; Monica, Fabio; Cannizzaro, Renato; Muscatiello, Nicola.

In: Clinical Gastroenterology and Hepatology, Vol. 16, No. 8, 01.08.2018, p. 1209-1219.e9.

Research output: Contribution to journalReview article

Facciorusso, Antonio ; Del Prete, Valentina ; Buccino, Rosario Vincenzo ; Della Valle, Nicola ; Nacchiero, Maurizio Cosimo ; Monica, Fabio ; Cannizzaro, Renato ; Muscatiello, Nicola. / Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection : A Network Meta-analysis. In: Clinical Gastroenterology and Hepatology. 2018 ; Vol. 16, No. 8. pp. 1209-1219.e9.
@article{8b916bcd54784546baf8009f4dd8c300,
title = "Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection: A Network Meta-analysis",
abstract = "Background & Aims: Several add-on devices have been developed to increase rates of colon adenoma detection (ADR). We assessed their overall and comparative efficacy, and estimated absolute magnitude of benefit through a network meta-analysis. Methods: We searched the PubMed/Medline and Embase database through March 2017 and identified 25 randomized controlled trials (comprising 16,103 patients) that compared the efficacy of add-on devices (cap; Endocuff; Arc Medical Design Ltd, Leeds, UK, and Endorings; Us Endoscopy, Mentor, OH) with each other or with standard colonoscopy. The primary outcome was ADR; secondary outcomes included rate of polyp detection, and rate of and time to cecal intubation. We performed pairwise and network meta-analyses, and appraised quality of evidence using Grading of Recommendations Assessment, Development and Evaluation. We estimated the magnitude of increase in ADR by low-performing endoscopists (baseline ADR, 10{\%}) and high-performing endoscopists (baseline ADR, 40{\%}) with use of these devices. Results: Overall, distal attachment devices increased ADR compared with standard colonoscopy (relative risk [RR], 1.13; 95{\%} CI, 1.03–1.23; low-quality evidence), with potential absolute increases in ADR to 11.3{\%} for low-performing endoscopists and to 45.2{\%} for high-performing endoscopists. In a comparative evaluation, we found low-quality evidence that Endocuff increases ADR compared with standard colonoscopy (RR, 1.21; 95{\%} CI, 1.03–1.41), with anticipated increases in ADR to 12{\%} for low-performing endoscopists and to 48{\%} for high-performing endoscopists. We found very low quality evidence to support the use of Endorings (RR, 1.70; 95{\%} CI, 0.86–3.36) or caps (RR, 1.07; 95{\%} CI, 0.96–1.19) vs standard colonoscopy for increasing ADR. The benefit of one distal attachment device over another was uncertain due to very low quality evidence. Conclusions: Based on network meta-analysis, we anticipate only modest improvement in ADRs with use of distal attachment devices, especially in low-performing endoscopists.",
keywords = "Cap-Assisted, Colon Cancer, GRADE, Tumor",
author = "Antonio Facciorusso and {Del Prete}, Valentina and Buccino, {Rosario Vincenzo} and {Della Valle}, Nicola and Nacchiero, {Maurizio Cosimo} and Fabio Monica and Renato Cannizzaro and Nicola Muscatiello",
year = "2018",
month = "8",
day = "1",
doi = "10.1016/j.cgh.2017.11.007",
language = "English",
volume = "16",
pages = "1209--1219.e9",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "8",

}

TY - JOUR

T1 - Comparative Efficacy of Colonoscope Distal Attachment Devices in Increasing Rates of Adenoma Detection

T2 - A Network Meta-analysis

AU - Facciorusso, Antonio

AU - Del Prete, Valentina

AU - Buccino, Rosario Vincenzo

AU - Della Valle, Nicola

AU - Nacchiero, Maurizio Cosimo

AU - Monica, Fabio

AU - Cannizzaro, Renato

AU - Muscatiello, Nicola

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background & Aims: Several add-on devices have been developed to increase rates of colon adenoma detection (ADR). We assessed their overall and comparative efficacy, and estimated absolute magnitude of benefit through a network meta-analysis. Methods: We searched the PubMed/Medline and Embase database through March 2017 and identified 25 randomized controlled trials (comprising 16,103 patients) that compared the efficacy of add-on devices (cap; Endocuff; Arc Medical Design Ltd, Leeds, UK, and Endorings; Us Endoscopy, Mentor, OH) with each other or with standard colonoscopy. The primary outcome was ADR; secondary outcomes included rate of polyp detection, and rate of and time to cecal intubation. We performed pairwise and network meta-analyses, and appraised quality of evidence using Grading of Recommendations Assessment, Development and Evaluation. We estimated the magnitude of increase in ADR by low-performing endoscopists (baseline ADR, 10%) and high-performing endoscopists (baseline ADR, 40%) with use of these devices. Results: Overall, distal attachment devices increased ADR compared with standard colonoscopy (relative risk [RR], 1.13; 95% CI, 1.03–1.23; low-quality evidence), with potential absolute increases in ADR to 11.3% for low-performing endoscopists and to 45.2% for high-performing endoscopists. In a comparative evaluation, we found low-quality evidence that Endocuff increases ADR compared with standard colonoscopy (RR, 1.21; 95% CI, 1.03–1.41), with anticipated increases in ADR to 12% for low-performing endoscopists and to 48% for high-performing endoscopists. We found very low quality evidence to support the use of Endorings (RR, 1.70; 95% CI, 0.86–3.36) or caps (RR, 1.07; 95% CI, 0.96–1.19) vs standard colonoscopy for increasing ADR. The benefit of one distal attachment device over another was uncertain due to very low quality evidence. Conclusions: Based on network meta-analysis, we anticipate only modest improvement in ADRs with use of distal attachment devices, especially in low-performing endoscopists.

AB - Background & Aims: Several add-on devices have been developed to increase rates of colon adenoma detection (ADR). We assessed their overall and comparative efficacy, and estimated absolute magnitude of benefit through a network meta-analysis. Methods: We searched the PubMed/Medline and Embase database through March 2017 and identified 25 randomized controlled trials (comprising 16,103 patients) that compared the efficacy of add-on devices (cap; Endocuff; Arc Medical Design Ltd, Leeds, UK, and Endorings; Us Endoscopy, Mentor, OH) with each other or with standard colonoscopy. The primary outcome was ADR; secondary outcomes included rate of polyp detection, and rate of and time to cecal intubation. We performed pairwise and network meta-analyses, and appraised quality of evidence using Grading of Recommendations Assessment, Development and Evaluation. We estimated the magnitude of increase in ADR by low-performing endoscopists (baseline ADR, 10%) and high-performing endoscopists (baseline ADR, 40%) with use of these devices. Results: Overall, distal attachment devices increased ADR compared with standard colonoscopy (relative risk [RR], 1.13; 95% CI, 1.03–1.23; low-quality evidence), with potential absolute increases in ADR to 11.3% for low-performing endoscopists and to 45.2% for high-performing endoscopists. In a comparative evaluation, we found low-quality evidence that Endocuff increases ADR compared with standard colonoscopy (RR, 1.21; 95% CI, 1.03–1.41), with anticipated increases in ADR to 12% for low-performing endoscopists and to 48% for high-performing endoscopists. We found very low quality evidence to support the use of Endorings (RR, 1.70; 95% CI, 0.86–3.36) or caps (RR, 1.07; 95% CI, 0.96–1.19) vs standard colonoscopy for increasing ADR. The benefit of one distal attachment device over another was uncertain due to very low quality evidence. Conclusions: Based on network meta-analysis, we anticipate only modest improvement in ADRs with use of distal attachment devices, especially in low-performing endoscopists.

KW - Cap-Assisted

KW - Colon Cancer

KW - GRADE

KW - Tumor

UR - http://www.scopus.com/inward/record.url?scp=85047605652&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047605652&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2017.11.007

DO - 10.1016/j.cgh.2017.11.007

M3 - Review article

AN - SCOPUS:85047605652

VL - 16

SP - 1209-1219.e9

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 8

ER -