Ricerc@Sapienza

AIMS: To assess the efficacy of Endocuff Vision (EV) in order to improve stability, to reduce operation time and complication rate during ¿difficult¿ colon polypectomy.
BACKGROUND : Polyp size, location and morphology have a significant impact on the difficult of endoscopic polypectomy. Size, Morphology, Site, Access (SMSA) is a scoring system to grade the difficulty during polypectomy. With increasing difficult, the risk of complications, recurrence and malignancy also increase.
The EV is a new endoscopic device that is attached like a cap to the distal tip of the colonoscope. The device has eight flexible branches that are used to flatten the folds of the colon.The use of EV significantly improves the Adenoma Detection Rate (ADR).
METHODS 14 non consecutive patients entered in a preliminary randomized prospective study. Block randomization of the two groups- Endocuff Vision polypectomy (EP), Standard polypectomy (SP)- is performed. The stability was calculated as the number of attempts to maintain the right position of the scope while performing polypectomy. Main demographics, clinical, procedural and polyps¿ characteristics were recorded. Polyps with SMSA scoring system ¿ 8 are considered difficult.
RESULTS: 14 patients are enrolled (Males 1, Median age 66 years). Seven patients underwent EP and seven patients SP. Three patients who underwent EP presented two different difficult polyps for a total of ten lesions. 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 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.
Conclusion: More endoscopic procedures are needed to assess the efficacy of EV. In our opinion the EV could facilitate the endoscopic approach to ¿difficult¿ colonic lesions improving stability.