Mechanical Attachment Enhances Colonoscopy Effectiveness

A novel device mounted on the tip of a colonoscope enhances mucosal visualization by holding back and unfolding colonic folds.

The Olympus Medical (Olympus; Tokyo, Japan) Endocuff Vision is designed to maintain and maximize the viewable mucosa during endocosopic procedures by manipulating colonic folds using a single row of flexible retractable arms that evert and flatten the mucosa, providing an enhanced view of the entire colon. The arms also help to prevent slippage during withdrawal, stabilize the scope tip during examination and polypectomy, and reduce difficulties associated with looping.

Key features include four different color-coded sizes; a hard plastic body and firm, dry grip on the scope that prevents dislodgement and protect the distal tip of the colonoscope; and hinged arms that fit seamlessly into the device. The arms are designed so that they fall flat against the scope, creating a low profile for smooth forward movement during intubation. Upon withdrawal, the hinged arms expand to gently flatten large mucosal folds, bringing elusive areas into view. The soft, flexible arms provide just the right amount of force to be effective without causing mucosal trauma.

A recent study at NYU Langone Medical Center (New York, NY, USA) that assessed 200 people 40 years and younger undergoing screening or surveillance colonoscopy randomly assigned 101 to colonoscopy with the device and 99 to standard colonoscopy. Demographic characteristics were similar in the two groups, as was bowel preparation quality. The results revealed that inspection time with the Vision was on average nearly two minutes faster than in the standard group, with no reduction in adenoma detection rate (ADR). The study was presented at American College of Gastroenterology (ACG) annual scientific meeting, held during October 2018 in Philadelphia (PA, USA).

“The adenoma detection rate is the most important marker of colonoscopy quality. This is a unique study in the sense that it is looking to see if improving our efficiency impacts our detection rate,” said lead author and study presenter Seth Gross, MD, of NYU Langone. “With this device, we had a higher detection rate but a shorter withdrawal time, suggesting that with mechanical enhancement, you are more efficient.”

Colonoscopy is the endoscopic examination of the colon and the distal part of the small bowel with a video or fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected lesions.