Skip to main content
SpringerLink
Log in

Adenoma and Advanced Adenoma Detection Rates of Water Exchange, Endocuff, and Cap Colonoscopy: A Network Meta-Analysis with Pooled Data of Randomized Controlled Trials

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

A network meta-analysis showed that low-cost optimization of existing resources was as effective as distal add-on devices in increasing adenoma detection rate (ADR). We assessed the impacts of water exchange (WE), Endocuff, and cap colonoscopy on ADR and advanced adenoma detection rate (AADR). We hypothesized that WE may be superior at improving ADR and AADR.

Methods

The literature was searched for all randomized controlled trials (RCTs) that reported ADR as an outcome and included the keywords colonoscopy, and water exchange, Endocuff, or cap. We performed traditional network meta-analyses with random effect models comparing ADR and AADR of each method using air insufflation (AI) as the control and reported the odds ratios with 95% confidence interval. Performances were ranked based on P-score.

Results

Twenty-one RCTs met inclusion criteria. Fourteen RCTs also reported AADR. Both WE [1.46 (1.20–1.76)] and Endocuff [1.39 (1.17–1.66)] significantly increase ADR, while cap has no impact on ADR [1.00 (0.82–1.22)]. P-scores for WE (0.88), Endocuff (0.79), cap (0.17), and AI (0.17) suggest WE has the highest ADR. WE [1.38 (1.12–1.70)], but not Endocuff [0.96 (0.76–1.21)] or cap [1.06 (0.85–1.32)], significantly increases AADR. P-scores for WE (0.98), cap (0.50), AI (0.31), and Endocuff (0.21) suggest WE is more effective at increasing AADR. The results did not change after adjusting for age, proportion of males, and withdrawal time.

Conclusion

WE may be the modality of choice to maximally improve ADR and AADR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Abbreviations

AADR:

Advanced adenoma detection rate

ADR:

Adenoma detection rate

AI:

Air insufflation

BBPS:

Boston Bowel Preparation Scale

CI:

Confidence interval

CRC:

Colorectal cancer

EC:

Endocuff

IC:

Interval cancer

OR:

Odds ratio

RCTs:

Randomized controlled trials

SUCRA:

Surface under the cumulative ranking curve

WE:

Water exchange

References

  1. Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. New England Journal of Medicine. 2010;362:1795–1803.

    CAS  Google Scholar 

  2. Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:1298–1306.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Hsieh YH, Leung FW. Increase your adenoma detection rate without using fancy adjunct tools. Ci Ji Yi Xue Za Zhi. 2018;30:127–134.

    PubMed  Google Scholar 

  4. Fuccio L, Frazzoni L, Hassan C, et al. Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies. Gastrointest Endosc. 2018;88:589–597.

    PubMed  Google Scholar 

  5. Cadoni S, Hassan C, Frazzoni L, et al. Impact of water exchange colonoscopy on endoscopy room efficiency: a systematic review and meta-analysis. Gastrointest Endosc. 2019;89:159–167.

    PubMed  Google Scholar 

  6. Facciorusso A, Triantafyllou K, Murad MH, et al. Compared abilities of endoscopic techniques to increase colon adenoma detection rates: a network meta-analysis. Clin Gastroenterol Hepatol. 2019;17:2439–2454.e25.

    PubMed  Google Scholar 

  7. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    PubMed  PubMed Central  Google Scholar 

  8. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    PubMed  PubMed Central  Google Scholar 

  9. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials. 1996;17:1–12.

    CAS  PubMed  Google Scholar 

  10. Lieberman DA, Rex DK, Winawer SJ, et al. United States Multi-Society Task Force on Colorectal Cancer. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844–857.

    PubMed  Google Scholar 

  11. Rücker G, Schwarzer G. Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Med Res Methodol. 2015;31:58.

    Google Scholar 

  12. Rex DK, Repici A, Gross SA. 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.

    PubMed  Google Scholar 

  13. Tang Z, et al. Impact of cap-assisted colonoscopy on learning curve and quality in colonoscopy: a randomized controlled trial. Gastrointest Endosc. 2018;87:723–732.

    PubMed  Google Scholar 

  14. Ngu WS, et al. Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial. Gut. 2019;68:280–288.

    PubMed  Google Scholar 

  15. Biecker E, et al. Novel endocuff-assisted colonoscopy significantly increases the polyp detection rate: a randomized controlled trial. J Clin Gastroenterol. 2015;49:413–418.

    PubMed  Google Scholar 

  16. Hsieh Y-H, Koo M, Leung FW. A patient-blinded randomized, controlled trial comparing air insufflation, water immersion, and water exchange during minimally sedated colonoscopy. Am J Gastroenterol. 2014;109:1390.

    PubMed  Google Scholar 

  17. Floer M, Biecker E, Fitzlaff R, et al. Higher adenoma detection rates with endocuff-assisted colonoscopy—a randomized controlled multicenter trial. PLoS ONE. 2014;9:e114267.

    PubMed  PubMed Central  Google Scholar 

  18. Arai M, Okimoto K, Ishigami H, et al. A randomized controlled trial comparing water exchange and air insufflation during colonoscopy without sedation. Int J Colorect Dis. 2016;31:1217–1223.

    Google Scholar 

  19. Bhattacharyya R, Chedgy F, Kandiah K, et al. Endocuff-assisted vs. standard colonoscopy in the fecal occult blood test-based UK Bowel Cancer Screening Programme (E-cap study): a randomized trial. Endoscopy. 2017;49:1043–1050.

    PubMed  Google Scholar 

  20. Van Doorn SC, Van der Vlugt M, Depla AC, et al. Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicentre randomised controlled trial. Gut. 2017;66:438–445.

    PubMed  Google Scholar 

  21. González-Fernández C, García-Rangel D, Aguilar-Olivos NE, et al. Higher adenoma detection rate with the endocuff: a randomized trial. Endoscopy. 2017;49:1061–1068.

    PubMed  Google Scholar 

  22. Wada Y, Fukuda M, Ohtsuka K, et al. Efficacy of Endocuff-assisted colonoscopy in the detection of colorectal polyps. Endosc Int Open. 2018;6:E425–E431.

    PubMed  PubMed Central  Google Scholar 

  23. Cadoni S, Gallittu P, Sanna S, et al. A two-center randomized controlled trial of water-aided colonoscopy versus air insufflation colonoscopy. Endoscopy. 2014;46:212–218.

    PubMed  Google Scholar 

  24. Cadoni S, et al. Water exchange for screening colonoscopy increases adenoma detection rate: a multicenter, double-blinded, randomized controlled trial. Endoscopy. 2017;49:456–467.

    PubMed  Google Scholar 

  25. Garborg K, Kaminski MF, Lindenburger W, et al. Water exchange versus carbon dioxide insufflation in unsedated colonoscopy: a multicenter randomized controlled trial. Endoscopy. 2015;47:192–199.

    PubMed  Google Scholar 

  26. Hsieh Y-H, Tseng CW, Hu CT, et al. Prospective multicenter randomized controlled trial comparing adenoma detection rate in colonoscopy using water exchange, water immersion, and air insufflation. Gastrointest Endosc. 2017;86:192–201.

    PubMed  Google Scholar 

  27. Jia H, Pan Y, Guo X, et al. Water exchange method significantly improves adenoma detection rate: a multicenter, randomized controlled trial. Am J Gastroenterol. 2017;112:568–576.

    PubMed  Google Scholar 

  28. Lee YT, Lai LH, Hui AJ, et al. Efficacy of cap-assisted colonoscopy in comparison with regular colonoscopy: a randomized controlled trial. Am J Gastroenterol. 2009;104:41.

    PubMed  Google Scholar 

  29. Othman MO, Zhang D, Elhanafi S, et al. Cap-assisted colonoscopy increases detection of advanced adenomas and polyps. Am J Med Sci. 2017;353:367–373.

    PubMed  Google Scholar 

  30. Pohl H, Bensen SP, Toor A, et al. Cap-assisted colonoscopy and detection of Adenomatous Polyps (CAP) study: a randomized trial. Endoscopy. 2015;47:891–897.

    PubMed  Google Scholar 

  31. Rastogi A, Bansal A, Rao DS, et al. Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial. Gut. 2012;61:402–408.

    PubMed  Google Scholar 

  32. de Wijkerslooth TR, Stoop EM, Bossuyt PM, et al. Adenoma detection with cap-assisted colonoscopy versus regular colonoscopy: a randomised controlled trial. Gut. 2012;61:1426–1434.

    PubMed  Google Scholar 

  33. Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739–750.

    PubMed  Google Scholar 

  34. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2015;110:72–90.

    PubMed  Google Scholar 

  35. Triantafyllou K, Gkolfakis P, Tziatzios G, et al. Effect of Endocuff use on colonoscopy outcomes: a systematic review and meta-analysis. World J Gastroenterol. 2019;25:1158.

    PubMed  PubMed Central  Google Scholar 

  36. 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.

    PubMed  Google Scholar 

  37. Greenspan M, Rajan KB, Baig A, et al. Advanced adenoma detection rate is independent of nonadvanced adenoma detection rate. Am J Gastroenterol. 2013;108:1286–1292.

    PubMed  Google Scholar 

  38. Leung FW, Koo M, Cadoni S, et al. Water exchange produces significantly higher adenoma detection rate than water immersion. J Clin Gastroenterol. 2019;53:204–209.

    PubMed  Google Scholar 

  39. Leung FW. Water exchange may be superior to water immersion for colonoscopy. Clin Gastroenterol Hepatol. 2011;9:1012–1014.

    PubMed  Google Scholar 

  40. Leung FW, Cheung R, Fan RS, et al. The water exchange method for colonoscopy-effect of coaching. J Interv Gastroenterol. 2012;2:122.

    PubMed  PubMed Central  Google Scholar 

  41. Leung FW. Water-aided colonoscopy. Gastroenterol Clin. 2013;42:507–519.

    Google Scholar 

  42. Yen AW. Insertion water exchange minimizes endoscopist multi-tasking during withdrawal inspection—a plausible explanation for enhanced polyp detection in the right colon. J Interv Gastroenterol. 2015;5:3.

    Google Scholar 

  43. Hsieh Y-H, Koo M, Tseng CW, et al. Reduction of multitasking distractions underlies the higher adenoma detection rate of water exchange compared to air insufflation–blinded analysis of withdrawal phase videos. United Eur Gastroenterol J. 2019;7:230–238.

    Google Scholar 

  44. Barret M, Boustiere C, Canard JM, et al. Factors associated with adenoma detection rate and diagnosis of polyps and colorectal cancer during colonoscopy in France: results of a prospective, nationwide survey. PLoS ONE. 2013;8:e68947.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Yun GY, Eun HS, Kim JS, et al. Colonoscopic withdrawal time and adenoma detection in the right colon. Medicine (Baltimore). 2018;97:e12113.

    Google Scholar 

Download references

Funding

This study was supported in part by the VA and ASGE Research Funds and the China Scholarship Council Research Grant. All authors declare that they are free from other sources of external funding related to this study.

Author information

Authors and Affiliations

  1. David Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Suite 7236, Los Angeles, CA, 90095-7417, USA

    Paul P. Shao, Aileen Bui, Tahmineh Romero & Felix W. Leung

  2. VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA, USA

    Paul P. Shao, Aileen Bui, Hui Jia & Felix W. Leung

  3. VA Sepulveda Ambulatory Care Center, 6111 Plummer St, North Hills, CA, USA

    Paul P. Shao, Aileen Bui, Hui Jia & Felix W. Leung

Authors
  1. Paul P. Shao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aileen Bui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tahmineh Romero
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hui Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Felix W. Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PS was involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript, and approval of final draft submitted. AB and HJ were involved in study design, acquisition of data, interpretation of data, critical revision of the manuscript, and approval of final draft submitted. TR was involved in study design, statistical analysis of data, interpretation of data, critical revision of the manuscript, and approval of final draft submitted. FL was involved in study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, overall study supervision, and approval of final draft submitted.

Corresponding author

Correspondence to Paul P. Shao.

Ethics declarations

Conflict of interest

The authors had no financial conflicts to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See Tables 4, 5, and 6.

Table 4 PRIMSA7 checklist
Full size table
Table 5 Assessment of risk of bias in the included studies with Cochrane Collaboration’s tool8
Full size table
Table 6 Quality assessment of the included studies with Jadad scale9
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shao, P.P., Bui, A., Romero, T. et al. Adenoma and Advanced Adenoma Detection Rates of Water Exchange, Endocuff, and Cap Colonoscopy: A Network Meta-Analysis with Pooled Data of Randomized Controlled Trials. Dig Dis Sci 66, 1175–1188 (2021). https://doi.org/10.1007/s10620-020-06324-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-020-06324-0

Keywords

Search

Navigation