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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 and Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Division of Gastroenterology, Department of Medicine, Bangkok, Thailand
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  • Krittaya Mekritthikrai
    Affiliations
    Gastrointestinal Endoscopy Excellence Center and Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Department of Medicine, 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 and Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

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

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

    Division of Gastroenterology, Department of Medicine, 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 and Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Division of Gastroenterology, Department of Medicine, Bangkok, Thailand
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  • Pinit Kullavanijaya
    Affiliations
    Gastrointestinal Endoscopy Excellence Center and Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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  • Rungsun Rerknimitr
    Correspondence
    Reprint requests: Rungsun Rerknimitr, MD, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
    Affiliations
    Gastrointestinal Endoscopy Excellence Center and Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Division of Gastroenterology, Department of Medicine, Bangkok, Thailand
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Published:October 08, 2022DOI:https://doi.org/10.1016/j.gie.2022.09.023

      Background and Aims

      Computer-aided detection (CADe) and a mucosal exposure device can improve adenoma detection rate (ADR). Potential benefits of combining the 2 modalities have never been studied. This study aimed to compare ADR differences among CADe alone, endocuff-assisted colonoscopy (EAC) alone, and the combination of CADe and EAC (CADe+EAC) with standard colonoscopy.

      Methods

      This prospective randomized controlled study included 1245 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 ADR (pADR), advanced ADR (AADR), and the number of adenomas per colonoscopy (APCs).

      Results

      ADRs from the control, CADe, EAC, and CADe+EAC groups were 41.9%, 52.2%, 54.0%, and 58.8%, respectively; pADRs were 25.2%, 33.3%, 34.9%, and 37.0%, respectively; AADRs were 7.7%, 8.3%, 8.3%, and 13.6%, respectively; and APCs were .76, 1.11, 1.18, and 1.31, respectively. Significant increases in ADR and pADR were observed between the intervention and control groups (P < .05 in all comparisons). The AADR was significantly higher only in the CADe+EAC group than in the control group (P = .02). The adjusted incidence rate ratios of APCs were significantly higher in the intervention groups versus the control group (P < .01 in all comparisons).

      Conclusions

      CADe+EAC significantly improve ADR and AADR over standard colonoscopy. However, although CADe or EAC alone can substantially increase the detection of adenomas, they do not lead to increased detection of advanced adenomas unless used in combination. (Clinical trial registration number: TCTR20200929003.)

      Abbreviations:

      AADR (advanced adenoma detection rate), ADR (adenoma detection rate), APC (adenoma per colonoscopy), CADe (computer-aided detection), CI (confidence interval), CRC (colorectal cancer), EAC (endocuff-assisted colonoscopy), IRR (incidence rate ratio), pADR (proximal adenoma detection rate), pAPC (proximal adenomas per colonoscopy)
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