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Research Article|Articles in Press

Performance and Attitudes Toward Real-time Computer-aided Polyp Detection during Colonoscopy in a Large Tertiary Referral Center in the United States

Published:February 17, 2023DOI:https://doi.org/10.1016/j.gie.2023.02.016
Performance and Attitudes Toward Real-time Computer-aided Polyp Detection during Colonoscopy in a Large Tertiary Referral Center in the United States
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      Abstract

      Background and Aims

      Computer aided detection (CADe) has been shown to improve polyp detection in clinical trials. Limited data exists on the impact, utilization, and attitudes toward artificial intelligence (AI)-assisted colonoscopy in daily clinical practice. We aimed to evaluate the effectiveness of the first FDA-approved CADe device in the United States and the attitudes toward its implementation.

      Methods

      Retrospective analysis of a prospectively maintained database of patients undergoing colonoscopy at a tertiary center in the United States before and after a real-time CADe system was made available. The decision to activate the CADe system was at the discretion of the endoscopist. An anonymous survey was circulated among endoscopy physicians and staff at the beginning and at the conclusion of the study period regarding their attitudes toward AI-assisted colonoscopy.

      Results

      CADe was activated in 52.1% of cases. Compared with historical controls, there was no statistically significant difference in adenomas detected per colonoscopy (APC) (1.08 vs 1.04, p=0.65), even after excluding diagnostic/therapeutic indications and cases where CADe was not activated (1.27 vs 1.17, p=0.45). In addition, there was no statistically significant difference in ADR, median procedure and withdrawal times. Survey results demonstrated mixed attitudes toward AI-assisted colonoscopy, of which main concerns included high number of false positive signals (82.4%), high level of distraction (58.8%), and impression it prolonged procedure time (47.1%).

      Conclusions

      CADe did not improve adenoma detection in daily practice among endoscopists with high baseline ADR. Despite its availability, AI-assisted colonoscopy was only activated in half of cases, and multiple concerns were raised by staff and endoscopists. Future studies will help elucidate the patients and endoscopists that would benefit most from AI-assisted colonoscopy.

      Keywords

      Acronyms and abbreviations:

      CADe (Computer aided detection), AI (artificial intelligence), APC (adenomas detected per colonoscopy), ADR (adenoma detection rate), CRC (Colorectal cancer), RCT (randomized controlled trial), SSLDR (sessile serrated lesion detection rate)
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      Article info

      Publication history

      Accepted: February 10, 2023
      Received in revised form: February 5, 2023
      Received: November 29, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosures

      Fredy Nehme: Nothing to disclose.

      Emmanuel Coronel: Nothing to disclose.

      Denise A. Barringer: Nothing to disclose.

      Laura Romero: Nothing to disclose.

      Mehnaz A. Shafi: Nothing to disclose.

      William A. Ross: Nothing to disclose.

      Phillip S. Ge: Alira Health (Consultant), Boston Scientific (Consultant), Ovesco America (Consultant), Neptune Medical (Consultant)

      Author Contributions

      Fredy Nehme: study concept and design, analysis and interpretation of data, drafting of manuscript

      Emmanuel Coronel: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript

      Denise A. Barringer: acquisition of data, analysis and interpretation of data, technical support

      Laura Romero: acquisition of data, analysis and interpretation of data, technical support

      Mehnaz A. Shafi: acquisition of data, analysis and interpretation of data, critical revision of manuscript

      William A. Ross: acquisition of data, analysis and interpretation of data, critical revision of manuscript

      Phillip S. Ge: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, study supervision

      All authors approved of the final submitted draft.

      Financial Support: None

      Potential competing interests: None

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.02.016

      Copyright

      © 2023 by the American Society for Gastrointestinal Endoscopy

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