Linked-color imaging with or without artificial intelligence for adenoma detection: a randomized trial

Abstract

Background and study aims: The adenoma detection rate (ADR) is an important indicator of colonoscopy quality and colorectal cancer incidence. Both linked color imaging (LCI) with artificial intelligence-assisted colonoscopy (LCA) and LCI alone (LC) increase adenoma detection, although it remains unclear whether one modality is superior. This study aimed to compare the ADR between LCA and LC. Furthermore, we evaluated differences in ADRs according to endoscopists’ experience (experts and trainees) and polyp size between the LCA and LC groups. Patients and methods: Patients undergoing colonoscopy for positive fecal immunochemical tests, follow-up of colon polyps, and abdominal symptoms at a single institution were randomly assigned to the LCA or LC group. The ADR, adenoma per colonoscopy (APC), cecal intubation time, withdrawal time, number of adenomas per location, and adenoma size were compared. Results: The LCA (n=400) and LC (n=400) groups showed comparable cecal intubation and withdrawal times. The LCA group showed a significantly higher ADR (58.8% vs 43.5%, p<0.001) and mean APC (1.31±1.65 vs. 0.94±1.42, p<0.001), particularly in the ascending colon (0.30±0.62 vs. 0.20±0.54, p=0.016). The total number of non-polypoid-type adenomas was also significantly higher in the LCA group (0.15±0.51 vs. 0.08±0.30, p=0.019). Small polyps (≤5 and 6–9 mm) were detected significantly more frequently in the LCA group (0.75±1.13 vs. 0.48±0.89, p<0.001 and 0.34±0.74 vs. 0.24±0.58, p=0.035). In both the groups, there was no significant difference in the ADR between experts and trainees. Conclusions: LCA is significantly superior to LC in terms of the ADR.