Use of Mechanical Enhanced Colonoscopy to Improve Polyp Detection During Colorectal Cancer Screening: A Real-World Healthcare Database Analysis

<b>Introduction:</b> High performance colonoscopy requires the monitoring of an individual's adenoma detection rate (ADR). The Endocuff (EndoCuff Vision, Olympus America Inc., Center Valley, PA, USA) is an endoscopic distal attachment device that increases surface area exposure during colonoscopy. While studies have shown that Endocuff increased ADR, real-world data is limited on its effectiveness. <b>Methods:</b> The Premiere Health Database was reviewed from 2018 to 2021 to identify patients 50 years of age or older who had a screening colonoscopy. A keyword search for "Endocuff" was used to determine if Endocuff was utilized, and ICD10 codes were analyzed to determine if a polyp was found. Our primary outcome was a polyp detection rate (PDR) for Endocuff-assisted colonoscopy (EAC) and standard colonoscopy (SC). Secondary outcomes included an estimated adenoma detection rate (eADR). Logistic regression modeling was performed to examine the difference in PDR between the EAC and SC groups after controlling for baseline characteristics, insurance type, and provider experience. <b>Results:</b> Gastroenterologists performed 893,560 screening colonoscopies, of which 0.7% were Endocuff-assisted, while surgeons performed 234,962 screening colonoscopies and 0.5% were Endocuff-assisted. PDR was higher with EAC for both gastroenterologists (72.0% vs. 57.4%) and surgeons (55.6% vs. 43.7%), with eADR following similar trends. The odds ratio of polyp detection with vs. without Endocuff was 1.91 for gastroenterologists and 1.62 for surgeons. After adjusting for patient and provider factors, the adjusted odds ratios are 2.01 and 1.61, respectively. <b>Conclusions:</b> While Endocuff utilization remains low, this large study using real-world data demonstrates the ability to improve eADR by over 10% compared to standard colonoscopy.