Does computer-aided diagnostic endoscopy improve the detection of commonly missed polyps? A meta-analysis

Abstract

Background/Aims: Colonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions.Methods: A comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling.Results: Seven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09–0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02–0.07).Conclusions: CADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.

Eye tracking technology in endoscopy: Looking to the future

“…2 There are multiple factors contributing to successful adenoma detection. Technological improvements such as high-definition colonoscopy and imaging technologies including computer aided diagnostic endoscopy (CADe) improve the detection of lesions 3 and endoscopic adjuncts such as EndoCuff improve the exposure of lesions with a demonstrable improvement of ADR. 4,5 The visual patterns of an endoscopist, that is, what the endoscopist is looking at during luminal examination of the colon, is an interesting area of endoscopy with an evolving evidence base.…”

“…There are multiple factors contributing to successful adenoma detection. Technological improvements such as high‐definition colonoscopy and imaging technologies including computer aided diagnostic endoscopy (CADe) improve the detection of lesions 3 and endoscopic adjuncts such as EndoCuff improve the exposure of lesions with a demonstrable improvement of ADR 4,5 …”

Artificial intelligence and the push for small adenomas: all we need?

“…They all show a more or less significant increase in detection of small adenomas. The same results are summarized over and over again in no less than 16 meta-analyses 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 , plus a protocol for a further one 36 , as well as a meta-analysis of some of these meta-analyses 37 !…”

Pouring some water into the wine—Poor performance of endoscopists in artificial intelligence studies

“…The first studies using approved AI systems unanimously demonstrated an increase of adenoma detection rate (ADR), number of adenomas per patient as well as a reduction in adenoma and neoplasia miss rate that was mainly achieved due to detection of small and diminutive polyps. [2][3][4][5] In some studies, the high number of additional polyps detected with AI could at least in parts be attributed to a low baseline ADR in the control groups. 6 In their paper, Silvia Pecere and colleagues performed an analysis of published data.…”

“…The first studies using approved AI systems unanimously demonstrated an increase of adenoma detection rate (ADR), number of adenomas per patient as well as a reduction in adenoma and neoplasia miss rate that was mainly achieved due to detection of small and diminutive polyps 2–5 …”