Effect of Real-Time Computer-Aided Polyp Detection System (ENDO-AID) on Adenoma Detection in Endoscopists-in-Training: A Randomized Trial

Louis H S Lau; Jacky C L Ho; Jimmy C T Lai; Agnes H Y Ho; Claudia W K Wu; Vincent W H Lo; Carol M S Lai; Markus W Scheppach; Felix Sia; Kyle H K Ho; Xiang Xiao; Terry C F Yip; Thomas Y T Lam; Hanson Y H Kwok; Heyson C H Chan; Rashid N Lui; Ting-Ting Chan; Marc T L Wong; Man-Fung Ho; Rachel C W Ko; Sok-Fei Hon; Simon Chu; Koari Futaba; Simon S M Ng; Hon-Chi Yip; Raymond S Y Tang; Vincent W S Wong; Francis K L Chan; Philip W Y Chiu; ENDOAID-TRAIN study group

doi:10.1016/j.cgh.2023.10.019

Effect of Real-Time Computer-Aided Polyp Detection System (ENDO-AID) on Adenoma Detection in Endoscopists-in-Training: A Randomized Trial

Clin Gastroenterol Hepatol. 2024 Mar;22(3):630-641.e4. doi: 10.1016/j.cgh.2023.10.019. Epub 2023 Nov 2.

Authors

Louis H S Lau¹, Jacky C L Ho², Jimmy C T Lai², Agnes H Y Ho², Claudia W K Wu², Vincent W H Lo², Carol M S Lai³, Markus W Scheppach⁴, Felix Sia⁵, Kyle H K Ho⁵, Xiang Xiao⁶, Terry C F Yip⁷, Thomas Y T Lam⁸, Hanson Y H Kwok², Heyson C H Chan², Rashid N Lui², Ting-Ting Chan², Marc T L Wong², Man-Fung Ho³, Rachel C W Ko³, Sok-Fei Hon³, Simon Chu³, Koari Futaba³, Simon S M Ng⁹, Hon-Chi Yip⁹, Raymond S Y Tang¹, Vincent W S Wong¹, Francis K L Chan¹, Philip W Y Chiu¹⁰; ENDOAID-TRAIN study group

Affiliations

¹ Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR.
² Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
³ Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
⁴ Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
⁵ Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR.
⁶ Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong SAR.
⁷ Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong SAR.
⁸ Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong SAR.
⁹ Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
¹⁰ Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR. Electronic address: philipchiu@surgery.cuhk.edu.hk.

PMID: 37918685
DOI: 10.1016/j.cgh.2023.10.019

Abstract

Background: The effect of computer-aided polyp detection (CADe) on adenoma detection rate (ADR) among endoscopists-in-training remains unknown.

Methods: We performed a single-blind, parallel-group, randomized controlled trial in Hong Kong between April 2021 and July 2022 (NCT04838951). Eligible subjects undergoing screening/surveillance/diagnostic colonoscopies were randomized 1:1 to receive colonoscopies with CADe (ENDO-AID[OIP-1]) or not (control) during withdrawal. Procedures were performed by endoscopists-in-training with <500 procedures and <3 years' experience. Randomization was stratified by patient age, sex, and endoscopist experience (beginner vs intermediate level, <200 vs 200-500 procedures). Image enhancement and distal attachment devices were disallowed. Subjects with incomplete colonoscopies or inadequate bowel preparation were excluded. Treatment allocation was blinded to outcome assessors. The primary outcome was ADR. Secondary outcomes were ADR for different adenoma sizes and locations, mean number of adenomas, and non-neoplastic resection rate.

Results: A total of 386 and 380 subjects were randomized to CADe and control groups, respectively. The overall ADR was significantly higher in the CADe group than in the control group (57.5% vs 44.5%; adjusted relative risk, 1.41; 95% CI, 1.17-1.72; P < .001). The ADRs for <5 mm (40.4% vs 25.0%) and 5- to 10-mm adenomas (36.8% vs 29.2%) were higher in the CADe group. The ADRs were higher in the CADe group in both the right colon (42.0% vs 30.8%) and left colon (34.5% vs 27.6%), but there was no significant difference in advanced ADR. The ADRs were higher in the CADe group among beginner (60.0% vs 41.9%) and intermediate-level (56.5% vs 45.5%) endoscopists. Mean number of adenomas (1.48 vs 0.86) and non-neoplastic resection rate (52.1% vs 35.0%) were higher in the CADe group.

Conclusions: Among endoscopists-in-training, the use of CADe during colonoscopies was associated with increased overall ADR. (ClinicalTrials.gov, Number: NCT04838951).

Keywords: ADR; Adenoma Detection Rate; CADe; Colonoscopy; Computer-Aided Polyp Detection; Training.

Publication types

Randomized Controlled Trial

MeSH terms

Adenoma* / diagnosis
Colonic Polyps* / diagnosis
Colonoscopy / methods
Colorectal Neoplasms* / diagnosis
Computers
Humans
Polyps*
Single-Blind Method

Associated data

ClinicalTrials.gov/NCT04838951