Endorings™ In Screening Colonoscopy: Results of A Single Centre Pilot Study
Gut 2016;65:A224 doi:10.1136/gutjnl-2016-312388.418
Colonoscopy remains the gold standard procedure for screening and polyp detection, with adenoma detection rate (ADR) being a widely-accepted key performance indicator (KPI). It has long been recognised that even experienced endoscopists incur an appreciable ‘miss-rate’ and a number of novel devices have been marketed to assist this aspect of practice. The Endorings™ device is a simple soft silicone, single-use device consisting of a series of rings arranged around a central tubular core. As the colonoscope is inserted the rings fold backward to allow intubation and flare on withdrawal to flatten colonic folds and aid inspection.
Prospective data was collected during screening colonoscopy (performed by two accredited colonoscopists) when the Endorings™ device was used and compared the KPI results to outcomes from the previous few months, for the same two colonoscopists) when the device was not in use (ie. historical controls).
The ADR without Endorings™ (n = 85) was 49.4% with a per-procedure detection rate (ppr) of 0.97. With Endorings (n = 66) 66.7% (p = 0.0006) with ppr of 1.625. This represents a 35% increase in ADR and a 68% increase in the number of polyps detected at any given procedure. There were no significant differences in completion rates, withdrawal time, use of sedation or comfort scores. The device was removed in 5/66 procedures due to interference with intubation (in the presence of either an angulated sigmoid or diverticulosis). No complications were recorded.
Use of the Endorings™ device was associated with a significant increase in ADR. Qualitatively, the three-ring design was felt to interfere with normal intubation such that insertion technique had to be modified. An updated design iteration with two rings in slightly different positions along the central tube, has been produced and appears to offer a significant advantage in this regard. Furthermore, the central tube can be pushed further along the distal end of the colonoscope to allow the terminal ileum to be intubated with the device in place. The Endorings™ may offer an advantage in screening colonoscopy and, in this cohort, further prospective investigation is warranted.