Enhanced adenoma detection with Endocuff Vision: a GRADE assessed systematic review and meta-analysis

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Background/Aims: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths and the third most common cancer worldwide. Detecting adenomas during colonoscopy reduces the CRC risk, with higher adenoma detection rates (ADRs) correlating with lower CRC incidence and mortality. Endocuff Vision (EV) enhances mucosal visualization and may improve ADRs. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Embase, and Cochrane databases were searched through April 2025 for studies comparing EV-assisted and standard colonoscopy. The primary outcomes of interest were the ADRs, polyp detection rates (PDRs), and adverse events (AEs). Outcomes were pooled using a random-effects meta-analysis model and are presented as risk ratios (RRs) and mean differences. Heterogeneity in the pooled outcomes was assessed using the Higgins I². Results: Thirty-four studies (43,702 participants) were included. EV significantly improved ADRs (RR, 1.15; 95% confidence interval [CI],1.07-1.25) and PDRs (RR, 1.16; 95% CI, 1.10-1.23). EV also improved lesion detection in the left colon (RR, 1.23; 95% CI, 1.11-1.35) and right colon (RR, 1.19; 95% CI, 1.09-1.29). No significant improvement was observed in advanced ADRs or cecal intubation. EV use was associated with more AEs. Conclusions: EV-assisted colonoscopy improved ADRs and PDRs in both colonic regions and enhanced CRC screening despite increased AEs.