Mechanical auxiliary devices to expose mucosal surface in colonoscopy

Area of Science:

• Gastroenterology
• Endoscopic technology
• Colorectal cancer prevention

Background:

• Colonoscopy quality is crucial for colorectal cancer (CRC) prevention, with adenoma detection rate (ADR) as a key metric.
• Variability in ADR and missed lesions (flat, serrated, right-sided) persist due to inadequate mucosal exposure.
• Suboptimal visualization often occurs in areas obscured by folds and flexures.

Purpose of the Study:

• To critically review the efficacy of behind-folds visualizing techniques and technologies (BFTs) in enhancing mucosal exposure during colonoscopy.
• To evaluate the impact of BFTs on adenoma detection rate (ADR) and overall colonoscopy quality.
• To identify practical and effective BFTs for improving colorectal neoplasia detection.

Main Methods:

• Systematic review and meta-analysis of current data on various BFTs, including add-on devices (caps, Endocuff, EndoRings) and integrated technologies (G-EYE, FUSE, Third Eye).
• Appraisal of evidence regarding the effectiveness of BFTs in improving ADR, especially for endoscopists with lower baseline performance.
• Assessment of device practicality, accessibility, and cost-effectiveness.

Main Results:

• Meta-analyses indicate that BFTs can improve ADR, particularly benefiting endoscopists with lower baseline ADR.
• Simple, low-cost devices like Endocuff and caps demonstrate a favorable balance of effectiveness, accessibility, and ease of use.
• Emerging evidence suggests potential additive benefits from combining mechanical BFTs with artificial intelligence systems.

Conclusions:

• BFTs are pragmatic tools for optimizing colonoscopy quality and reducing post-colonoscopy colorectal cancer.
• Selective implementation of BFTs, especially in lower-performing settings, is recommended.
• BFTs should be considered a key component of modern endoscopic practice for enhanced colorectal neoplasia detection.