Van Doorn et al recently reported that Endocuff, an endoscopic cap with plastic projections fitted onto the distal end of the colonoscope increases adenoma detection rates (ADRs).1 While the study is of impeccable design and the device demonstrates to be safe and helpful to improve the inspection of colonic folds, there remain open questions concerning the Endocuff as well as for similar novel ADR enhancing modalities currently emerging on the market. Do they merely improve ADR as a function of improved detection of diminutive adenomas, and if so does such an ‘enhanced’ ADR actually contribute to colorectal cancer (CRC) prevention? Are there potential downsides on cost-effectiveness through increased polypectomy rates, possible clinically futile shortened surveillance intervals with potential attendant complication risks?

While ADR has …