CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(01): E41-E50
DOI: 10.1055/a-1293-7327

Efficacy of Endocuff Vision compared to first-generation Endocuff in adenoma detection rate and polyp detection rate in high-definition colonoscopy: a systematic review and network meta-analysis

Muhammad Aziz
1   Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
Hossein Haghbin
2   Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
Manesh Kumar Gangwani
3   Department of Internal Medicine, Mercy Hospital St. Louis, St. louis, Missouri, 63141
Sachit Sharma
4   Department of Internal Medicine, University of Toledo and Promedica Toledo Hospital, Toledo, Ohio, United States
Yusuf Nawras
2   Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
Zubair Khan
5   Department of Gastroenterology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, United States
Saurabh Chandan
6   Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
Babu P. Mohan
7   Divison of Gastroenterology and Hepatology, University of Utah Healthcare, Salt Lake City, Utah, United States
Wade Lee-Smith
8   University of Toledo Libraries, University of Toledo Medical Center, Toledo, Ohio, United States
Ali Nawras
1   Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
› Author Affiliations


Background and study aims Recently, the newer Endocuff Vision (ECV) has been evaluated for improving colonoscopy outcome metrics such as adenoma detection rate (ADR) and polyp detection rate (PDR). Due to lack of direct comparative studies between ECV and original Endocuff (ECU), we performed a systematic review and network meta-analysis to evaluate these outcomes.

Methods The following databases were searched: PubMed, Embase, Cochrane, and Web of Sciences to include randomized controlled trials (RCTs) comparing ECV or ECU colonoscopy to high-definition (HD) colonoscopy. Direct as well as network meta-analyses comparing ADR and PDR were performed using a random effects model. Relative-risk (RR) with 95 % confidence interval (CI) was calculated.

Results A total of 12 RCTs with 8638 patients were included in the final analysis. On direct meta-analysis, ECV did not demonstrate statistically improved ADR compared to HD colonoscopy (RR: 1.12, 95 % CI 0.99–1.27). A clinically and statistically improved PDR was noted for ECV compared to HD (RR: 1.15, 95 % CI 1.03–1.28) and ECU compared to HD (RR: 1.26, 95 % CI 1.09–1.46) as well as improved ADR (RR: 1.22, 95 % CI 1.05–1.43) was observed for ECU colonoscopy when compared to HD colonoscopy. These results were also consistent on network meta-analysis. Lower overall complication rates (RR: 0.14, 95 % CI 0.02–0.84) and particularly lacerations/erosions (RR: 0.11, 95 % CI 0.02–0.70) were noted with ECV compared to ECU colonoscopy.

Conclusions Although safe, the newer ECV did not significantly improve ADR compared to ECU and HD colonoscopy. Further device modification is needed to increase the overall ADR and PDR.

Supplementary material

Publication History

Received: 16 July 2020

Accepted: 30 September 2020

Article published online:
01 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (

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  • References

  • 1 Allemani C, Rachet B, Weir HK. et al. Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study. BMJ open 2013; 3: e003055
  • 2 Cancer of the Colon and Rectum - Cancer Stat Facts. (n.d.). Available at (Accessed on March 11, 2020):
  • 3 Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology 2010; 138: 2088-2100
  • 4 Rex DK, Petrini JL, Baron TH. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2006; 63: S16-S28
  • 5 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
  • 6 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
  • 7 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
  • 8 Aziz M, Sharma S, Fatima R. et al. How to increase proximal adenoma detection rate: a meta-analysis comparing water exchange, water immersion and air/CO2 insufflation methods for colonoscopy. Ann Gastroenterol 2020; 33: 178-186
  • 9 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.e11
  • 10 Aziz M, Weissman S, Khan Z. et al. Use of 2 observers increases adenoma detection rate during colonoscopy: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2019; pii: S1542-3565(19)30777-3
  • 11 Aziz M, Sharma S, Ghazaleh S. et al. The anti-spasmodic effect of peppermint oil during colonoscopy: a systematic review and meta-analysis. Minerva Gastroenterol Dietol 2020; DOI: 10.23736/S1121-421X.20.02652-5.
  • 12 Desai M, Bilal M, Hamade N. et al. Increasing adenoma detection rates in the right side of the colon comparing retroflexion with a second forward view: a systematic review. Gastrointest Endosc 2019; 89: 453-459.e3
  • 13 Aziz M, Fatima R, Dong C. et al. The impact of deep convolutional neural network-based artificial intelligence on colonoscopy outcomes: A systematic review with meta-analysis. J Gastroenterol Hepatol 2020; DOI: 10.1111/jgh.15070.
  • 14 Gkolfakis P, Tziatzios G, Spartalis E. et al. Colonoscopy attachments for the detection of precancerous lesions during colonoscopy: A review of the literature. World J Gastroenterol 2018; 24: 4243-4253
  • 15 Ngu WS, Bevan R, Tsiamoulos ZP. et al. Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial. Gut 2019; 68: 280-288
  • 16 Williet N, Tournier Q, Vernet C. et al. Effect of Endocuff-assisted colonoscopy on adenoma detection rate: meta-analysis of randomized controlled trials. Endoscopy 2018; 50: 846-860
  • 17 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: 1158-1170
  • 18 Chin M, Karnes W, Jamal MM. et al. Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis. World J Gastroenterol 2016; 22: 9642-9649
  • 19 Jian HX, Feng BC, Zhang Y. et al. EndoCuff-assisted colonoscopy could improve adenoma detection rate: A meta-analysis of randomized controlled trials. J Dig Dis 2019; 20: 578-588
  • 20 Rücker G, Schwarzer G. Resolve conflicting rankings of outcomes in network meta-analysis: Partial ordering of treatments. Res Synth Methods 2017; 8: 526-536
  • 21 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
  • 22 Dias S, Welton NJ, Caldwell DM. et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med 2010; 29: 932-944
  • 23 Puhan MA, Schunemann HJ, Murad MH. et al. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ 2014; 349: g5630
  • 24 Higgins J, Altman D, Gotzsche P. et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928-d5928
  • 25 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
  • 26 Biecker E, Floer M, Heinecke A. et al. Novel endocuff-assisted colonoscopy significantly increases the polyp detection rate: a randomized controlled trial. J Clin Gastroenterol 2015; 49: 413-418
  • 27 De Palma GD, Giglio MC, Bruzzese D. et al. Cap cuff-assisted colonoscopy versus standard colonoscopy for adenoma detection: a randomized back-to-back study. Gastrointest Endosc 2018; 87: 232-240
  • 28 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
  • 29 Jacob A, Schafer A, Yong J. et al. Endocuff Vision-assisted colonoscopy: a randomized controlled trial. ANZ J Surg 2019; 89: E174-E178
  • 30 Rex DK, Slaven JE, Garcia J. et al. Endocuff Vision reduces inspection time without decreasing lesion detection: a clinical randomized trial. Clin Gastroenterol Hepatol 2020; 18: 158-162.e1
  • 31 van Doorn SC, van der Vlugt M, Depla A. et al. Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicentre randomised controlled trial. Gut 2017; 66: 438-445
  • 32 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
  • 33 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 2020; 52: 45-51
  • 34 Rex DK, Repici A, Gross SA. et al. 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.e2
  • 35 Karsenti D, Tharsis G, Perrot B. et al. Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial. Gut 2020; 0: 1-6
  • 36 Kaminski MF, Wieszczy P, Rupinski M. et al. Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. Gastroenterology 2017; 153: 98-105
  • 37 Aziz M, Desai M, Hassan S. et al. Improving serrated adenoma detection rate in the colon by electronic chromoendoscopy and distal attachment: systematic review and meta-analysis. Gastrointest Endosc 2019; 90: 721-731.e1
  • 38 Aziz M, Fatima R, Lee-Smith W. et al. Comparing endoscopic interventions to improve serrated adenoma detection rates during colonoscopy: a systematic review and network meta-analysis of randomized controlled trials. Eur J Gastroenterol Hepatol 2020; DOI: 10.1097/MEG.0000000000001844.
  • 39 Anderson JC, Butterly LF, Goodrich M. et al. Differences in detection rates of adenomas and serrated polyps in screening versus surveillance colonoscopies, based on the New Hampshire colonoscopy registry. Clin Gastroenterol Hepatol 2013; 11: 1308-1312