Comparative Efficacy Of Different Computer-Aided Detection Products in Colonoscopy: A Network Meta-Analysis Of Randomized Controlled Trials.

BACKGROUND AND AIMS: Multiple computer-aided detection (CADe) systems have been developed to improve adenoma detection during colonoscopy, but their comparative efficacy and consistency of effect remain uncertain. This network meta-analysis aimed to compare the efficacy of different CADe systems across multiple detection outcomes.

METHODS

MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing CADe-assisted colonoscopy versus colonoscopy without CADe or other CADe systems. The primary outcome was adenoma detection rate (ADR). Secondary outcomes were adenomas per colonoscopy (APC) and adenoma miss rate (AMR). A random-effects network meta-analysis was performed to synthesize direct and indirect evidence.

RESULTS

Forty-one RCTs (31,789 patients; 14 CADe systems) were included. In the exploratory complete-network analysis, 10 of 14 systems significantly improved ADR (RR range 1.12-1.76), 9 increased APC, and 3 reduced AMR. In the FDA-cleared systems analysis, 3 of 6 improved ADR (RR range 1.14-1.25), whereas 3 did not. Several systems retained a significant benefit in studies meeting the control-arm ADR thresholds recommended by ESGE (≥25%) and ASGE/ACG (≥35%), although effects varied across platforms and attenuation at higher baseline ADR was not uniform. Baseline ADR was not associated with treatment effects in meta-regression.

CONCLUSIONS

The effectiveness of CADe-assisted colonoscopy is not uniform across platforms and varies according to the specific product. These findings support a system-specific rather than class-based evaluation of CADe technologies. However, comparative estimates should be interpreted cautiously given the low certainty of evidence for several outcomes and the absence of head-to-head comparisons and closed loops within the network.