Browsing by Author "Floer, Martin"

Objectives: The Endocuff is a device mounted on the tip of the colonoscope to help flatten the colonic folds during withdrawal. This study aimed to compare the adenoma detection rates between Endocuff-assisted (EC) colonoscopy and standard colonoscopy (SC). Methods: This randomized prospective multicenter trial was conducted at four academic endoscopy units in Germany. Participants: 500 patients (235 males, median age 64[IQR 54-73]) for colon adenoma detection purposes were included in the study. All patients were either allocated to EC or SC. The primary outcome measure was the determination of the adenoma detection rates (ADR). Results: The ADR significantly increased with the use of the Endocuff compared to standard colonoscopy (35.4%[95% confidence interval{CI} 29-41%] vs. 20.7%[95% CI 15-26%], p<0.0001). Significantly more sessile polyps were detected by EC. Overall procedure time and withdrawal time did not differ. Caecal and ileum intubation rates were similar. No major adverse events occurred in both groups. In multivariate analysis, age (odds ratio [OR] 1.03; 95%[CI] 1.01-1.05), male sex (OR 1.74; 95% CI 1.10-2.73), withdrawal time (OR 1.16; 95% CI 1.05-1.30), procedure time (OR 1.07; 95% CI 1.04-1.10), colon cleanliness (OR 0.60; 95% CI 0.39-0.94) and use of Endocuff (OR 2.09; 95% CI 1.34-3.27) were independent predictors of adenoma detection rates. Conclusions: EC increases the adenoma detection rate by 14.7%(95% CI 6.9-22.5%). EC is safe, effective, easy to handle and might reduce colorectal interval carcinomas.

Goals and Background: Screening colonoscopy for colorectal cancer has proven to reduce mortality rates. Recently the Endocuff (EC), an attachment to the distal tip of the colonoscope, was introduced. The aim of our study was to compare EC-assisted colonoscopies with standard colonoscopies for the detection of colonic polyps. Study: This study is a randomized prospective 2-center trial. The study was conducted at 2 tertiary care centers. Participants: A total of 498 patients [249 males; median age 67 y; interquartile range (IQR), 56-75 y] for colon adenoma screening purposes were included. All patients underwent standard colonoscopy with or without the use of EC. Overall polyp detection rate, the number of colonic polyps, and the polyp distribution in the colon were measured. Difference in recognition of polyps with or without the use of EC was assessed. Statistical analysis was applied. Results: In the EC group, the number of polyps detected per patient was 63% higher [2.00 (IQR, 1.00-4.00) vs. 1.00 (IQR, 1.00-2.25), P < 0.0001]. The polyp detection rate in patients increased by 14% with the use of EC (56% vs. 42%, P= 0.001). For polyp detection, superiority by use of EC could be observed in the sigmoid (P= 0.001) and cecum (P= 0.002) for polyps < 1 cm in diameter. In the EC group, the number of adenomas detected per patient significantly increased by 86% (P= 0.002). No major complications occurred in both groups. Conclusions: The use of the EC is feasible and safe with significantly higher polyp detection rates, especially for those located in the sigmoid region. The cuff system has the potential to improve the accuracy of screening colonoscopies.

A 71-year-old woman was admitted to our emergency department due to sore throat and swelling of the neck and face. She had a history of chronic obstructive pulmonary disease grade 4 based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Clinical examination revealed subcutaneous emphysema of the neck and face. CT scan of the thorax and abdomen showed air in the retroperitoneum, ascending through the mediastinum into the neck and face. Laparotomy confirmed the diagnosis of a retroperitoneal colon perforation due to colon diverticulitis. The colon was partially removed followed by a surgical debridement and Hartmann's procedure. The postoperative course was without complications, the clinical symptoms resolved rapidly.