Ricerc@Sapienza

Background and aim: Polyp size, location and morphology have
a significant impact on the difficult of endoscopic polypectomy.
Polyps longer than 2 cm in diameter or located in particular
anatomic regions (involving the ileocecal valve, close to the dentate
line, in an area that is difficult to access, or peridiverticular polyps)
are considered difficult polyps.
Size, Morphology, Site, Access (SMSA) is a scoring system to grade
the difficulty during polypectomy (Table 1). With increasing difficult,
the risk of complications, recurrence and malignancy also
increase. The Endocuff Vision (ECV) is a new endoscopic device
that is attached like a cap to the distal tip of the colonoscope. The
use of endocuff significantly improves the Adenoma Detection Rate
(ADR). To assess the efficacy of Endocuff Vision in order to improve
stability, to reduce operation time and complication rate during
“difficult” colon polypectomy.
Material and methods: A total of 14 non consecutive patients
entered in a randomized prospective study. Block randomization
of the two groups- Endocuff Vision polypectomy (EP), Standard
polypectomy (SP) is performed by using computerized randomization
lists. A video recording during the procedure is obtained for
all patient. Initial assessment was performed with a conventional
colonoscope and no endoscopic accessories. If endoscopic access is
considered difficult and one or more complex polyps are observed,
the endoscope is withdrawn and the endocuff is placed randomly.
In patients with previous colonoscopy, in which a difficult polyp
has been diagnosed, the endocuff is attached to the colonoscope
at the begininning of the procedure. The overall procedure time,
polypectomy time and withdrawal time was recorded. The stability
was calculated as the number of attempts to maintain the right
position of the scope while performing polypectomy. Procedural
complications, such as bleeding and perforation, were also recorded.
Polyps with SMSA scoring system ≥8 were considered difficult.
Results: 14 patients are enrolled (males 1, median age 66 years).
Seven patients underwent EP and seven patients SP. All patients
obtained a good bowel preparation (Boston Bowel Preparation Scale
(BBPS) = ≥6). The median procedure time was 63.6 minutes for
EP (max = 95; min = 26) and 40.3 for SP (max = 73; min = 18).
The polypectomy time was 25.6 minutes (range = 8–60) and 25.3
(range 7–59) respectively. The maximum polypectomy time was
60 minutes in a patient with a 8 centimeter sessile polyp of the
rectum who underwent EP. The stability was 2.6 attempts for EP
(range = 1–9) and 4.6 for SP (range = 3–11). The median SMSA score
was 10 (min = 8; max = 16) and 12 (min = 9; max = 15) respectively.
One patient (SP) showed bleeding in 5th postoperative day
treated endoscopically and one patient (SP) underwent surgery for
a preforation. The polyps’ characteristics are represented in Table 2.
Conclusions: More endoscopic procedures are needed to assess the
efficacy of Endocuff Vision.