ENDORINGS ASSISTED COLONOSCOPY VERSUS STANDARD COLONOSCOPY FOR POLYP DETECTION IN SYMPTOMATIC AND ASYMPTOMATIC PATIENTS: A RANDOMISED CONTROLLED TRIAL

Aims:

The Endorings is a distal attachment consisting of two layers of circular flexible rings that evert mucosal folds. Aims; to investigate if Endorings Colonoscopy (ER) improves polyp and adenoma detection compared to standard colonoscopy (SC).

Methods:

This multi-centre, parallel group, randomized controlled trial included screening, surveillance and symptomatic patients. Primary outcome; number of polyps per patient. Secondary outcomes; number of adenomas per patient, adenoma/polyp detection rates and withdrawal times.

Results:

Total of 556 patients (214 females, 342 males) randomized to ER (275) or SC (281). Mean age 67. Colonoscopy completed 532/556 (96%) cases. EndoRings removed in 74/275 (27%) patients. In 66/74 (89%) cases removal was performed due to difficulties with sigmoid intubation. Remainder removed to facilitate retroflexion or polyp removal/retrieval. Total number of polyps in ER limb 571 vs. 444 in SC limb. Total number of adenomas in ER limb 361 vs. 343 for SC limb. Our study showed a statistically significant difference in the mean number of polyps per patient in both the Intention To Treat (ITT) (1.8 SC vs. 2.1 ER, p-value 0.02) and Per Protocol (PP) (1.8 SC vs. 2.25 ER, p-value 0.009).

Tab. 1:

Intention to Treat Analysis

	Standard Colonoscopy (SC)	Encoring-Assisted Colonoscopy (ER)	P value
Mean polyps per patient	1.8	2.1	0.02
Mean adenomas per patient	1.2	1.3	0.38
Polyp detection rate	67.5%	75.2%	0.05
Adenoma detection rate	57%	61.4%	0.28

There was a trend towards a greater polyp detection rate in the ER colonoscopy (67.5% SC vs. 75.2% ER, p-value 0.05).

Conclusions:

Despite the high removal rate of Endorings, there was a statistically significant increase in the mean number of polyps in the ER limb compared to the SC limb. Our study shows promise for the EndoRings device to improve polyp detection.