• Carolina Mangas-Sanjuan, Luisa de-Castro, Joaquín Cubiella, Pilar Díez-Redondo, Adolfo Suárez, María Pellisé, Nereida Fernández, Sara Zarraquiños, Henar Núñez-Rodríguez, Verónica Álvarez-García, Oswaldo Ortiz, Noelia Sala-Miquel, Pedro Zapater, Rodrigo Jover, and CADILLAC study investigators.
• Department of Gastroenterology, Hospital General Universitario Dr. Balmis, Servicio de Medicina Digestiva, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Spain (C.M., N.S.).
• Ann. Intern. Med. 2023 Sep 1; 176 (9): 114511521145-1152.

BackgroundThe role of computer-aided detection in identifying advanced colorectal neoplasia is unknown.ObjectiveTo evaluate the contribution of computer-aided detection to colonoscopic detection of advanced colorectal neoplasias as well as adenomas, serrated polyps, and nonpolypoid and right-sided lesions.DesignMulticenter, parallel, randomized controlled trial. (ClinicalTrials.gov: NCT04673136).SettingSpanish colorectal cancer screening program.Participants3213 persons with a positive fecal immunochemical test.InterventionEnrollees were randomly assigned to colonoscopy with or without computer-aided detection.MeasurementsAdvanced colorectal neoplasia was defined as advanced adenoma and/or advanced serrated polyp.ResultsThe 2 comparison groups showed no significant difference in advanced colorectal neoplasia detection rate (34.8% with intervention vs. 34.6% for controls; adjusted risk ratio [aRR], 1.01 [95% CI, 0.92 to 1.10]) or the mean number of advanced colorectal neoplasias detected per colonoscopy (0.54 [SD, 0.95] with intervention vs. 0.52 [SD, 0.95] for controls; adjusted rate ratio, 1.04 [99.9% CI, 0.88 to 1.22]). Adenoma detection rate also did not differ (64.2% with intervention vs. 62.0% for controls; aRR, 1.06 [99.9% CI, 0.91 to 1.23]). Computer-aided detection increased the mean number of nonpolypoid lesions (0.56 [SD, 1.25] vs. 0.47 [SD, 1.18] for controls; adjusted rate ratio, 1.19 [99.9% CI, 1.01 to 1.41]), proximal adenomas (0.94 [SD, 1.62] vs. 0.81 [SD, 1.52] for controls; adjusted rate ratio, 1.17 [99.9% CI, 1.03 to 1.33]), and lesions of 5 mm or smaller (polyps in general and adenomas and serrated lesions in particular) detected per colonoscopy.LimitationsThe high adenoma detection rate in the control group may limit the generalizability of the findings to endoscopists with low detection rates.ConclusionComputer-aided detection did not improve colonoscopic identification of advanced colorectal neoplasias.Primary Funding SourceMedtronic.

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