Stasinos I, Voulgaris T, Kouimtsidis IA, Zantza SA, Leventaki FA, Theodosopoulos TA, Vlachogiannakos J, Apostolopoulos PA, Karamanolis GP. Impact of Endocuff addition to real-time computer-aided detection of colorectal neoplasia in a randomised tandem colonoscopy trial. World J Gastrointest Pharmacol Ther 2026; 17(1): 112825 [DOI: 10.4292/wjgpt.v17.i1.112825]
Corresponding Author of This Article
Theodoros Voulgaris, MD, PhD, Department of Endoscopy, 2nd Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Vas Sofias 76, Athens 11528, Attikí, Greece. thvoulgaris87@gmail.com
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Gastroenterology & Hepatology
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Randomized Controlled Trial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 5, 2026 (publication date) through Feb 11, 2026
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World Journal of Gastrointestinal Pharmacology and Therapeutics
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2150-5349
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Stasinos I, Voulgaris T, Kouimtsidis IA, Zantza SA, Leventaki FA, Theodosopoulos TA, Vlachogiannakos J, Apostolopoulos PA, Karamanolis GP. Impact of Endocuff addition to real-time computer-aided detection of colorectal neoplasia in a randomised tandem colonoscopy trial. World J Gastrointest Pharmacol Ther 2026; 17(1): 112825 [DOI: 10.4292/wjgpt.v17.i1.112825]
World J Gastrointest Pharmacol Ther. Mar 5, 2026; 17(1): 112825 Published online Mar 5, 2026. doi: 10.4292/wjgpt.v17.i1.112825
Impact of Endocuff addition to real-time computer-aided detection of colorectal neoplasia in a randomised tandem colonoscopy trial
Ioannis Stasinos, Theodoros Voulgaris, Ioannis A Kouimtsidis, Sofia A Zantza, Fwteini A Leventaki, Theodosios A Theodosopoulos, John Vlachogiannakos, Periklis A Apostolopoulos, Georgios P Karamanolis
Ioannis Stasinos, Department of Gastroenterology, 417 Army Equity Fund Hospital (NIMTS), Athens 11528, Attikí, Greece
Theodoros Voulgaris, Theodosios A Theodosopoulos, Georgios P Karamanolis, Department of Endoscopy, 2nd Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Attikí, Greece
Ioannis A Kouimtsidis, Sofia A Zantza, Fwteini A Leventaki, Periklis A Apostolopoulos, Department of Gastroenterology, NIMTS Medical Institution Military Shareholder Fund, Athens 11528, Attikí, Greece
John Vlachogiannakos, Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Attikí, Greece
Author contributions: Stasinos I finalized the manuscript; Stasinos I and Voulgaris T wrote the initial draft; Stasinos I and Apostolopoulos PA performed colonoscopy procedures; Stasinos I, Voulgaris T, Kouimtsidis IA, Zantza SA, and Leventaki FA were implicated in data collection; Theodosopoulos TA, Vlachogiannakos J, Apostolopoulos PA, and Karamanolis GP reviewed the manuscript. All authors have read and approved the final manuscript.
Institutional review board statement: A formal ethical approval was received by the Research and Ethics Committee of Aretaieion University Hospital (approval No. 489/14-03-2023).
Clinical trial registration statement: This study is registered at ClinicalTrials.gov. The registration identification number is 26847/21.03.2023.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Data are available upon request. Readers may contact the corresponding author to request underlying data.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Theodoros Voulgaris, MD, PhD, Department of Endoscopy, 2nd Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Vas Sofias 76, Athens 11528, Attikí, Greece. thvoulgaris87@gmail.com
Received: August 7, 2025 Revised: September 8, 2025 Accepted: November 26, 2025 Published online: March 5, 2026 Processing time: 188 Days and 18.2 Hours
Abstract
BACKGROUND
Risk of post colonoscopy colorectal cancer is related to adenoma miss rate (AMR) during colonoscopy. Artificial intelligence (AI) and Endocuff Vision are tools both used to increase adenoma detection rate (ADR).
AIM
To assess whether the combination of AI and Endocuff vision, compared to using AI alone, increases the ADR.
METHODS
This is a single-center randomized, tandem colonoscopy trial. Patients with a Boston Bowel Preparation score ≥ 6 with an indication of colorectal cancer screening (78, 91.8%) or polyp surveillance (7, 8.2%) were included from the study.
RESULTS
Eighty-five patients were included in total (male: 51; mean age: 63 ± 8 years old). In 39 patients, the initial colonoscopy was performed using AI alone, while in 45 patients, it was carried out with a combination of AI and Endocuff. Colonoscopies without Endocuff were associated with a numerically higher ADR (19/39, 48.7% vs 14/45, 31.1%, P = 0.107) and an increased number of polyps detected per procedure (1.7 ± 2.5 vs 1.2 ± 1.4, P = 0.272). During tandem colonoscopy, an additional 0.4 ± 0.8 polyps per examination (polyp miss rate = 0.08 ± 0.15), along with 0.3 ± 0.7 adenomas (AMR = 0.10 ± 0.25), were identified. Adding Endocuff to AI during tandem colonoscopy did not provide any benefit in AMR or polyp miss rate when compared to initial AI combined with Endocuff-assisted endoscopy followed by tandem AI-only procedures (0.11 ± 0.24 vs 0.92 ± 0.27, P = 0.727; and 0.10 ± 0.15 vs 0.07 ± 0.14, P = 0.415, respectively).
CONCLUSION
Adding Endocuff to AI-assisted colonoscopy, according to our results, does not lead to increased adenoma detection.
Core Tip: Adenoma detection rate (ADR) is associated with a decreased risk of developing interval colorectal cancer, whereas the adenoma miss rate during colonoscopy is related to the risk of post-colonoscopy colorectal cancer. Artificial intelligence (AI) and Endocuff Vision, have independently shown to enhance ADR. However, in our prospective tandem study assessing the combined use of Endocuff Vision and AI, we did not observe validation of previously published data indicating that adding Endocuff to AI-assisted colonoscopy improves overall polyp and ADRs.
