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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
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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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