Computer-aided detection in surveillance colonoscopy: a population-based randomized trial

Background and study aims: Computer-aided detection (CADe) increases adenoma detection in colonoscopy, but its effectiveness in post-polypectomy surveillance remains uncertain. This study compared CADe-assisted versus standard high-definition colonoscopy for adenoma detection rate (ADR) during surveillance. Patients and methods: We conducted a population-based, randomized controlled trial in the Galician colorectal cancer screening program. Colonoscopy days were randomized in a 1:1 ratio to high-definition colonoscopy with or without CADe. The primary endpoint was ADR. Prespecified subgroup analyses evaluated endoscopist baseline performance (median ADR in the standard arm). Effect estimates are reported as adjusted risk ratios (aRR) and confidence interval (CI). Results: Of 5,309 randomized surveillance colonoscopies, 4,824 surveillance colonoscopies were included in the final analysis (2,469 standard; 2,355 CADe-assisted) after exclusion of incomplete examinations. ADR did not differ between groups (57.4% vs 58.8%; aRR 1.02 [95% CI 0.95–1.10]). CADe increased ADR among low-performing (ADR<54.5%) endoscopists (45.5% vs 52.1%; aRR 1.15 [95% CI 1.01–1.30]), but not among high-performing endoscopists (65.9% vs 63.5%; aRR 0.96 [95% CI 0.88–1.05]). Conclusions: In a high-performing screening program, CADe did not increase ADR in surveillance colonoscopy. Its benefit may be limited to lower-performing endoscopists.