Randomized Trial of Hood with or without Wing Attachment-assisted Colonoscopy with Linked Color Imaging and Computer-aided in Adenoma Detection

Background and Aim: Computer-aided detection (CADe) combined with linked color imaging (LCI) has shown potential in improving adenoma detection rates during colonoscopies. However, the comparative effectiveness of these supportive methods, based on the type of tip hood, remains unclear. We aimed to compare the adenoma detection rate (ADR) between Endo-Wing-assisted colonoscopy with LCI and CADe (ELC) and transparent hood-assisted colonoscopy with LCI and CADe (TLC). Methods: This single-center, non-blinded prospective randomized controlled trial enrolled 800 patients who underwent colonoscopy between August 2024 and August 2025. Participants were randomly assigned to either the ELC (n = 400) or TLC group (n = 400). The primary outcome was ADR. Secondary outcomes included the polyp detection rate, adenomas per colonoscopy, and procedural parameters. Results: The ELC group demonstrated a significantly higher ADR compared to the TLC group (58.00% vs. 39.75%, P < 0.001; relative risk 1.45, 95% CI: 1.25–1.67). This superiority was consistent among expert endoscopists (61.78% vs. 42.17%, P < 0.001) as well as trainees (53.14% vs. 35.76%, P = 0.002). Furthermore, the ELC group achieved a higher polyp detection rate (61.25% vs. 45.75%, P < 0.001) and recorded a greater number of adenomas per colonoscopy (1.17 vs. 0.73, P < 0.001). This advantage was particularly pronounced for small adenomas (≤5 mm) and sessile and flat lesions. Conclusions: ELC demonstrated a significant improvement in the ADR compared to the TLC approach, particularly for diminutive and sessile adenomas. This superiority was consistent across varying levels of endoscopist experience, indicating broad clinical applicability.