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Computer-aided detection, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: A randomized controlled trial

  • Satimai Aniwan
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    The Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Bangkok, Thailand
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  • Krittaya Mekritthikrai
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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  • Stephen J. Kerr
    Affiliations
    Biostatistics Excellence Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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  • Kasenee Tiankanon
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    The Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Bangkok, Thailand
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  • Kunvadee Vandaungden
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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  • Yingluk Sritunyarat
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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  • Panida Piyachaturawat
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    The Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Bangkok, Thailand
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  • Thanawat Luangsukrerk
    Affiliations
    Division of General Internal Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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  • Santi Kulpatcharapong
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    The Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Bangkok, Thailand
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  • Naruemon Wisedopas
    Affiliations
    Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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  • Natanong Kongtub
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    The Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Bangkok, Thailand
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  • Pinit Kullavanijaya
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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  • Rungsun Rerknimitr
    Correspondence
    Corresponding Author: Rungsun Rerknimitr, M.D. Division of Gastroenterology, Department of Medicine Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand Tel: 66-2-256-4265, Fax: 66-2-252-7839
    Affiliations
    Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    The Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Bangkok, Thailand
    Search for articles by this author
Published:October 08, 2022DOI:https://doi.org/10.1016/j.gie.2022.09.023
Computer-aided detection, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: A randomized controlled trial
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      Abstract

      Background and aims

      Computer-aided detection (CADe) and mucosal exposure device can improve adenoma detection rate (ADR). Potential benefits of combining the two modalities have never been studied. This study aimed to compare ADR differences among CADe alone, EAC alone, and the combination of CADe and EAC (CADe+EAC) with the standard colonoscopy.

      Methods

      This prospective randomized controlled study included 1,245 participants who underwent screening colonoscopy. Participants were randomized to CADe, EAC, CADe+EAC, and standard colonoscopy as a control. The primary outcome was ADR. Secondary outcomes were proximal adenoma detection rate (pADR), advanced adenoma detection rate (AADR), and the number of adenomas per colonoscopy (APC).

      Results

      ADRs from the control, CADe, EAC, and CADe+EAC groups were 41.9%, 52.2%, 54.0% and 58.8%, respectively. Their pADR were 25.2%, 33.3%, 34.9%, and 37.0%, respectively. Their AADR were 7.7%, 8.3%, 8.3%, and 13.6%, respectively. Their APC were 0.76, 1.11, 1.18, and 1.31, respectively. Significant increases in ADR and pADR were observed between the intervention and control groups (p<0.05 in all comparisons). The AADR was significantly higher only with the CADe+EAC group than with the control group (p=0.02). The adjusted incidence rate ratios of APC were significantly higher in the intervention groups versus the control group (p<0.01 in all comparisons).

      Conclusion

      CADe and EAC significantly improve ADR and AADR over standard colonoscopy. However, while CADe or EAC alone can substantially increase the detection of adenomas, they do not lead to increased detection of advanced adenoma unless used in combination.

      Keywords

      Abbreviations:

      AADR (advanced adenoma detection rate), AAPC (advanced adenomas per colonoscopy), ADR (adenoma detection rate), APC (adenomas per colonoscopy), BBPS (Boston Bowel Preparation Scale), BMI (body mass index), CADe (computer-aided detection), CI (confidence interval), EAC (Endocuff-assisted colonoscopy), IRR (incidence rate ratio), IQR (interquartile range), pADR (proximal adenoma detection rate), pAPC (proximal adenomas per colonoscopy), SD (standard deviation)
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      Article Info

      Publication History

      Accepted: September 23, 2022
      Received in revised form: August 16, 2022
      Received: June 23, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Trial registration: This study was registered at the Thai Clinical Trial Registry (TCTR20200929003).

      Specific author contributions:

      Satimai Aniwan – conducted the study, data interpretation, and drafted the manuscript

      Krittaya Mekritthikrai – collected data and reviewed the manuscript

      Stephen J Kerr – statistical analysis and reviewed the manuscript

      Kasenee Tiankanon - collected data and reviewed the manuscript

      Kunvadee Vanduangden - collected data and reviewed the manuscript

      Yingluk Sritunyarat - collected data and reviewed the manuscript

      Panida Piyachaturawat - collected data and reviewed the manuscript

      Thanawat Luangsukrerk - collected data and reviewed the manuscript

      Santi Kulpatcharapong - collected data and reviewed the manuscript

      Natanong Kongtab – collected data and reviewed the manuscript

      Naruemon Wisedopas – analyzed pathology data and reviewed the manuscript

      Pinit Kullavanijaya – reviewed the manuscript

      Rungsun Rerknimitr – study design and reviewed the manuscript

      All authors have approved the final draft submitted.

      Financial support: This project is funded by the National Research Council of Thailand (NRCT): N42A640330 and the Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University (RA65_CRC_003). Fujifilm provided the CADe system (CAD EYE, Fujifilm, Tokyo, Japan).

      Potential competing interests: None of the authors have any relevant conflicts of interests

      Identification

      DOI: https://doi.org/10.1016/j.gie.2022.09.023

      Copyright

      © 2022 by the American Society for Gastrointestinal Endoscopy

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