Endocuff Vision Made Polypectomy Faster

Douglas K. Rex, MD, FASGE reviewing von Figura G, et al. Endoscopy 2019 Oct 15.

Endocuff Vision (EV) has been shown in randomized controlled trials to increase the adenoma detection rate and shorten withdrawal time. Anecdotally, there are various opinions about the impact of EV on polypectomy ease and efficiency.

In a randomized controlled trial involving 14 experienced colonoscopists from Germany (>150 colonoscopies each), 125 patients underwent polypectomy with standard colonoscopy and 125 with EV. Polypectomy duration was measured from the start of passing the first instrument down the working channel of the colonoscope until completion of polypectomy. Median polypectomy duration was 54 seconds with EV versus 80 seconds with standard. There were greater differences with larger polyps. In lesions ≥10 mm, the difference in median time was 141 versus 250 seconds, and for 6 to 9 mm polyps, the difference was 53 versus 108 seconds. For diminutive lesions, the difference was 42 versus 59 seconds and did not reach significance. The number of lesions requiring more than one resection was lower with EV (17% vs 28%).


Comment:
EV has now been associated with higher adenoma detection rates, faster withdrawal times, while maintaining high detection, and now, faster polypectomy. The mechanism by which it speeds polypectomy is almost certainly to stabilize the colonoscope position during the time between detection and resection. This result is very consistent with my experience, though I have found particular instances when EV interferes with resection, such as a lesion on the medial wall of the cecum near the ileocecal valve, and sometimes in the sigmoid. In these instances, the simple bulk of the device seems to interfere with deflecting down enough for easy polyp capture.

Douglas K. Rex, MD, FASGE
Bio and Disclosures

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Citation(s):
von Figura G, Hasenöhrl M, Haller B, et al. Endocuff vision-assisted vs. standard polyp resection in the colorectum (the EVASTA study): a prospective randomized study. Endoscopy 2019 Oct 15. (Epub ahead of print) (https://doi.org/10.1055/a-1018-1870)