Background and Aims
Computer-assisted detection (CADe) is a promising technologic advance that enhances
adenoma detection during colonoscopy. However, the role of CADe in reducing missed
colonic lesions is uncertain. The aim of this study was to determine the miss rates
of proximal colonic lesions by CADe and conventional colonoscopy.
Methods
This was a prospective, multicenter, randomized, tandem-colonoscopy study conducted
in 3 Asian centers. Patients were randomized to receive CADe or conventional white-light
colonoscopy during the first withdrawal of the proximal colon (cecum to splenic flexure),
immediately followed by tandem examination of the proximal colon with white light
in both groups. The primary outcome was adenoma/polyp miss rate, which was defined
as any adenoma/polyp detected during the second examination.
Results
Of 223 patients (48.6% men; median age, 63 years) enrolled, 7 patients did not have
tandem examination, leaving 108 patients in each group. There was no difference in
the miss rate for proximal adenomas (CADe vs conventional: 20.0% vs 14.0%, P = .07) and polyps (26.7% vs 19.6%, P = .06). The CADe group, however, had significantly higher proximal polyp (58.0% vs
46.7%, P = .03) and adenoma (44.7% vs 34.6%, P = .04) detection rates than the conventional group. The mean number of proximal polyps
and adenomas detected per patient during the first examination was also significantly
higher in the CADe group (polyp: 1.20 vs .86, P = .03; adenoma, .91 vs .61, P = .03). Subgroup analysis showed that CADe enhanced proximal adenoma detection in
patients with fair bowel preparation, shorter withdrawal time, and endoscopists with
lower adenoma detection rate.
Conclusions
This multicenter trial from Asia confirmed that CADe can further enhance proximal
adenoma and polyp detection but may not be able to reduce the number of missed proximal
colonic lesions. (Clinical trial registration number: NCT04294355.)
Abbreviations:
ADR (adenoma detection rate), aOR (adjusted odds ratio), BBPS (Boston Bowel Preparation Scale), CADe (computer-assisted detection), CI (confidence interval), CRC (colorectal cancer)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 05, 2022
Accepted:
September 23,
2022
Received:
June 7,
2022
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: C. K. Yeung: Founder of NISI(HK) Limited. W. K. Leung: Advisory committee for NISI(HK) Limited; consultant for Medtronic. All other authors disclosed no financial relationships.
Identification
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© 2023 by the American Society for Gastrointestinal Endoscopy
