Can computer technology improve our everyday colonoscopy results?

A computer-aided detection (CADe) system did not ameliorate adenoma detection rates (ADR) compared with conventional colonoscopy (CC) among high-performing endoscopists in an international, randomised-controlled trial. However, CADe did improve performance in detecting sessile serrated lesions (SSLs).

“Although colonoscopy is the golden standard with respect to detecting adenomas, up to 26% of the adenomas are missed with this procedure,” stated Dr Michiel Maas (Radboud University Medical Center, the Netherlands) [1]. According to Dr Maas, CADe has shown promise for improving ADR during colonoscopy. He and his colleagues compared CADe with standard colonoscopy for diagnostics, surveillance, and non-immunochemical faecal occult blood test screening. In total, 581 individuals were randomised 1:1 to CADe or CC. The primary outcome measure was ADR.

No difference was seen between the CADe arm and the CC arm concerning ADR (38.4% vs 37.7%; P=0.86). Likewise, mean adenoma per colonoscopy was equal (0.66 for both arms; P=0.97). The polyp detection rates were also similar, with 55.2% and 51.4%, respectively (P=0.40). A sub-analysis of colonoscopy indication, adenoma location, and adenoma size did not reveal any differences between the 2 interventions. However, SSL per colonoscopy favoured the CADe arm over the CC arm (0.30 vs 0.19; P=0.049). In addition, an almost significant effect was observed for the SSL detection rate, suggesting that CADe may be better than CC at detecting these subtle lesions (18.4% vs 12.1%; P=0.053; see Figure). Finally, Dr Maas mentioned that lower-performing endoscopists appear to benefit more from CADe than their high-performing counterparts.

Figure: Primary and secondary outcomes of the comparison of CADe with CC [1]



CADe, computer-aided detection; CC, conventional colonoscopy; IQR, interquartile range.

“CADe did not increase ADR compared with CC for diagnostic, non-immunochemical faecal occult blood test screening, and surveillance colonoscopy but did increase SSL detection by 58%,” concluded Dr Maas.

1. 
   
   1. Maas MHJ, et al. A computer-aided detection system in the everyday setting of diagnostic screening and surveillance colonoscopy: an international, randomised, controlled trial. LB14, UEG Week 2023, 14–17 October, Copenhagen, Denmark.

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Posted on 7 December, 2023