February 05, 2020
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Computer-aided colonoscopy improves adenoma detection

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A computer-aided colonoscopy system helped detect adenomas that were initially missed by the endoscopist, according to study results.

Pu Wang, MD, of the department of gastroenterology at Sichuan Academy of Medical Sciences and Sichuan People’s Hospital in China, and colleagues wrote that even with recent advances in colorectal cancer screening technology, some adenomas are still missed.

“Polyps can still be overlooked, with up to 27% of polyps missed for various reasons,” they wrote. “Polyps that lie outside the visual field are one reason for not noticing adenomas, but unrecognized polyps within the visual field are equally important to address.”

Researchers evaluated colonoscopy with computer-aided detection (CADe) in a double-blind trial comprising 962 patients aged 18 to 75 years presenting for diagnostic and screening colonoscopy. They randomly assigned patients to undergo colonoscopy with the CADe system (n = 484) or colonoscopy with a sham program (n = 478).

The output of the CADe system was displayed on a separate monitor seen only by an observer who was responsible for reporting polyp alerts. The primary outcome of the study was adenoma detection rate.

In their analysis, Wang and colleagues found that ADR was greater in the CADe group than in the sham group. They detected at least one adenoma in 165 patients in the CADe group (34%) compared with 132 in the sham group (28%; OR = 1.36; 95% CI, 1.03–1.79).

Investigators found that the CADe was able to spot polyps that were initially missed, including ones that were small in size, isochromatic, flat, had an unclear boundary, were partly behind folds in the colon and were on the edge of the visual field.

While the CADe was safe and effective, Wang and colleagues wrote that more research is needed.

“We cannot draw the conclusion that increased ADR by CADe can absolutely lead to a decrease in colorectal cancer,” they wrote. “Long-term observation is needed to address this possibility. Because cost and availability of colonoscopy and polypectomy are different all over the world, cost-effectiveness research is also needed in different global regions.” – by Alex Young

Disclosure: Wang reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.