Computer-Aided Detection Improves Adenoma Detection Rate and Adenomas Per Colonoscopy in Fecal Immunochemical Test-Positive Patients

In parallel-arm randomized trials involving mostly primary screening and surveillance colonoscopy patients, computer-aided detection (CADe) has increased the adenoma detection rate (ADR) by about 10%. No prior study has had sufficient numbers of fecal immunochemical test (FIT)-positive patients to demonstrate benefit in this group. Because of the higher prevalence of adenomas in FIT-positive patients, the benefit of CADe-assisted colonoscopy could be blunted. 

In a randomized trial involving 800 FIT-positive patients, patients underwent high-definition white-light colonoscopy or CADe-assisted colonoscopy with Fujifilm CAD EYE (Tokyo, Japan). Fujifilm colonoscopes were used in all colonoscopies. 

The ADR was higher with CADe than without (53.6% vs 45.3%), as were adenomas per colonoscopy (APC; 1.13 vs 0.90) and advanced-ADR (18.5% vs 15.9%), but the difference in advanced-ADR was not significant. At least one sessile serrated lesion was detected in 5.6% of patients when CADe was used versus 4.8% when it was not, although this was also not significantly different.

When endoscopists were separated into 3 predefined baseline ADR groups, there were comparable gains in ADR, ranging from 7% to 11% among the 3 groups.