• Saeed Soleymanjahi, Jack Huebner, Lina Elmansy, Niroop Rajashekar, Nando Lüdtke, Rumzah Paracha, Rachel Thompson, Alyssa A Grimshaw, Farid Foroutan, Shahnaz Sultan, and Dennis L Shung.
• Division of Gastroenterology, Mass General Brigham, Harvard School of Medicine, Boston, Massachusetts (S.Soleymanjahi).
• Ann. Intern. Med. 2024 Oct 22.

BackgroundRandomized clinical trials (RCTs) of computer-aided detection (CADe) system-enhanced colonoscopy compared with conventional colonoscopy suggest increased adenoma detection rate (ADR) and decreased adenoma miss rate (AMR), but the effect on detection of advanced colorectal neoplasia (ACN) is unclear.PurposeTo conduct a systematic review to compare performance of CADe-enhanced and conventional colonoscopy.Data SourcesCochrane Library, Google Scholar, Ovid EMBASE, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection databases were searched through February 2024.Study SelectionPublished RCTs comparing CADe-enhanced and conventional colonoscopy.Data ExtractionAverage adenoma per colonoscopy (APC) and ACN per colonoscopy were primary outcomes. Adenoma detection rate, AMR, and ACN detection rate (ACN DR) were secondary outcomes. Balancing outcomes included withdrawal time and resection of nonneoplastic polyps (NNPs). Subgroup analyses were done by neural network architecture.Data SynthesisForty-four RCTs with 36 201 cases were included. Computer-aided detection-enhanced colonoscopies have higher average APC (12 090 of 12 279 [0.98] vs. 9690 of 12 292 [0.78], incidence rate difference [IRD] = 0.22 [95% CI, 0.16 to 0.28]) and higher ADR (7098 of 16 253 [44.7%] vs. 5825 of 15 855 [36.7%], rate ratio [RR] = 1.21 [CI, 1.15 to 1.28]). Average ACN per colonoscopy was similar (1512 of 9296 [0.16] vs. 1392 of 9121 [0.15], IRD = 0.01 [CI, -0.01 to 0.02]), but ACN DR was higher with CADe system use (1260 of 9899 [12.7%] vs. 1119 of 9746 [11.5%], RR = 1.16 [CI, 1.02 to 1.32]). Using CADe systems resulted in resection of almost 2 extra NNPs per 10 colonoscopies and longer total withdrawal time (0.53 minutes [CI, 0.30 to 0.77]).LimitationStatistically significant heterogeneity in quality and sample size and inability to blind endoscopists to the intervention in included studies may affect the performance estimates.ConclusionComputer-aided detection-enhanced colonoscopies have increased APC and detection rate but no difference in ACN per colonoscopy and a small increase in ACN DR. There is minimal increase in procedure time and no difference in performance across neural network architectures.Primary Funding SourceNone. (PROSPERO: CRD42023422835).

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