Impact of a ring-fitted cap on insertion time and adenoma detection: a randomized controlled trial

Douglas Rex, William Kessler, Sashidhar V. Sagi, Nicholas Rogers, Monika Fischer, Matthew Bohm, John Wo, John DeWitt, Lee McHenry, Rachel E. Lahr, Meghan P. Searight, Margaret MacPhail, Andrew W. Sullivan, Connor D. McWhinney, Krishna C. Vemulapalli

Research output: Contribution to journalArticle

Abstract

Background and Aims: Devices for flattening colon folds can improve polyp detection at colonoscopy. However, there are few data on the endoscopic ring-fitted cap (EndoRings; EndoAid, Caesarea, Israel). We sought to compare adenoma detection with EndoRings with that of standard high-definition colonoscopy. Methods: This was a single-center, randomized controlled trial of 562 patients (284 randomized to EndoRings and 278 to standard colonoscopy) at 2 outpatient endoscopy units in the Indiana University Hospital system. Adenoma detection was the primary outcome measured as adenoma detection rate (ADR) and adenomas per colonoscopy (APC). We also compared sessile serrated polyp detection rate, insertion times, withdrawal times, and ease of passage through the sigmoid colon. Results: EndoRings was superior to standard colonoscopy in terms of APC (1.46 vs 1.06, P =.025), but there were no statistically significant differences in ADR or sessile serrated polyp detection rate. Mean withdrawal time (in patients with no polyps) was shorter and insertion time (all patients) was longer in the EndoRings arm by 1.8 minutes and 0.75 minutes, respectively. One provider had significantly higher detection with Endo-Rings and contributed substantially to the overall results. Conclusions: EndoRings can increase adenoma detection without a significant increase in procedure time, but the effect varies between operators. The use of EndoRings slows colonoscope insertion. (Clinical trial registration number: NCT03418662.)

Original languageEnglish (US)
JournalGastrointestinal endoscopy
DOIs
StateAccepted/In press - Jan 1 2019

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Adenoma
Colonoscopy
Randomized Controlled Trials
Polyps
Colonoscopes
Sigmoid Colon
Israel
Endoscopy
Colon
Outpatients
Clinical Trials
Equipment and Supplies

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Impact of a ring-fitted cap on insertion time and adenoma detection : a randomized controlled trial. / Rex, Douglas; Kessler, William; Sagi, Sashidhar V.; Rogers, Nicholas; Fischer, Monika; Bohm, Matthew; Wo, John; DeWitt, John; McHenry, Lee; Lahr, Rachel E.; Searight, Meghan P.; MacPhail, Margaret; Sullivan, Andrew W.; McWhinney, Connor D.; Vemulapalli, Krishna C.

In: Gastrointestinal endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

Rex, Douglas ; Kessler, William ; Sagi, Sashidhar V. ; Rogers, Nicholas ; Fischer, Monika ; Bohm, Matthew ; Wo, John ; DeWitt, John ; McHenry, Lee ; Lahr, Rachel E. ; Searight, Meghan P. ; MacPhail, Margaret ; Sullivan, Andrew W. ; McWhinney, Connor D. ; Vemulapalli, Krishna C. / Impact of a ring-fitted cap on insertion time and adenoma detection : a randomized controlled trial. In: Gastrointestinal endoscopy. 2019.
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AU - Rex, Douglas

AU - Kessler, William

AU - Sagi, Sashidhar V.

AU - Rogers, Nicholas

AU - Fischer, Monika

AU - Bohm, Matthew

AU - Wo, John

AU - DeWitt, John

AU - McHenry, Lee

AU - Lahr, Rachel E.

AU - Searight, Meghan P.

AU - MacPhail, Margaret

AU - Sullivan, Andrew W.

AU - McWhinney, Connor D.

AU - Vemulapalli, Krishna C.

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N2 - Background and Aims: Devices for flattening colon folds can improve polyp detection at colonoscopy. However, there are few data on the endoscopic ring-fitted cap (EndoRings; EndoAid, Caesarea, Israel). We sought to compare adenoma detection with EndoRings with that of standard high-definition colonoscopy. Methods: This was a single-center, randomized controlled trial of 562 patients (284 randomized to EndoRings and 278 to standard colonoscopy) at 2 outpatient endoscopy units in the Indiana University Hospital system. Adenoma detection was the primary outcome measured as adenoma detection rate (ADR) and adenomas per colonoscopy (APC). We also compared sessile serrated polyp detection rate, insertion times, withdrawal times, and ease of passage through the sigmoid colon. Results: EndoRings was superior to standard colonoscopy in terms of APC (1.46 vs 1.06, P =.025), but there were no statistically significant differences in ADR or sessile serrated polyp detection rate. Mean withdrawal time (in patients with no polyps) was shorter and insertion time (all patients) was longer in the EndoRings arm by 1.8 minutes and 0.75 minutes, respectively. One provider had significantly higher detection with Endo-Rings and contributed substantially to the overall results. Conclusions: EndoRings can increase adenoma detection without a significant increase in procedure time, but the effect varies between operators. The use of EndoRings slows colonoscope insertion. (Clinical trial registration number: NCT03418662.)

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