Computer-assisted versus standard colonoscopy for adenoma detection in a population-based colorectal cancer screening program: a randomized clinical trial.

BACKGROUND

The impact of computer-aided detection (CADe) systems on lesion detection remains uncertain. We evaluated whether a CADe system improves adenoma detection rate (ADR) in a colorectal cancer (CRC) screening program.

METHODS

This multicenter randomized clinical trial included patients aged 40-79 years who underwent colonoscopy after a positive fecal immunochemical test (FIT) or for surveillance. Patients were randomized to either conventional or CADe-assisted colonoscopy. The primary end point was ADR. Secondary end points were detection rates for serrated lesions (SLDR), polyps (PDR), advanced adenomas (AADR), and advanced serrated lesions (ASLDR). We performed subgroup analysis according to indication, endoscopist ADR, and bowel cleansing. Effect estimates were reported as adjusted risk ratios (aRRs) and 95%CIs.

RESULTS

857 patients were randomized and 827 were included in the analysis. Baseline characteristics were comparable between groups (mean age: 61.7 [SD 6.5]; male 490; positive FIT: 552). We did not find statistically significant differences between CADe-assisted and conventional colonoscopy for ADR (60.8% vs. 57.7%; aRR 1.05, 95%CI 0.94-1.17). No significant differences were observed for SLDR (8.8% vs. 7.2%; aRR 1.04, 0.65-1.64), PDR (69.6% vs. 68.8%; aRR 1.00, 0.91-1.10), AADR (23.6% vs. 24.4%; aRR 0.90, 0.71-1.14), or ASLDR (4.9% vs. 4.8%; aRR 0.93, 0.51-1.68). Subgroup analysis showed no significant differences.

CONCLUSION

In colonoscopies performed in a CRC screening program, CADe-assisted colonoscopy did not increase ADR compared with conventional colonoscopy.