Tiankanon Kasenee, Aniwan Satimai, Kerr Stephen J, Mekritthikrai Krittaya, Kongtab Natanong, Wisedopas Naruemon, Piyachaturawat Panida, Kulpatcharapong Santi, Linlawan Sittikorn, Phromnil Poonrada, Muangpaisarn Puth, Orprayoon Theerapat, Chanyaswad Jaruwan, Sunthornwechapong Panukorn, Vateekul Peerapon, Kullavanijaya Pinit, Rerknimitr Rungsun
Division of Gastroenterology, Chulalongkorn University, Bangkok, Thailand.
Gastrointestinal Endoscopy Excellence Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Endoscopy. 2024 Apr;56(4):273-282. doi: 10.1055/a-2210-7999. Epub 2023 Nov 14.
BACKGROUND: This study aimed to evaluate the benefits of a self-developed computer-aided polyp detection system (SD-CADe) and a commercial system (CM-CADe) for high adenoma detectors compared with white-light endoscopy (WLE) as a control. METHODS: Average-risk 50-75-year-old individuals who underwent screening colonoscopy at five referral centers were randomized to SD-CADe, CM-CADe, or WLE groups (1:1:1 ratio). Trainees and staff with an adenoma detection rate (ADR) of ≥35% were recruited. The primary outcome was ADR. Secondary outcomes were the proximal adenoma detection rate (pADR), advanced adenoma detection rate (AADR), and the number of adenomas, proximal adenomas, and advanced adenomas per colonoscopy (APC, pAPC, and AAPC, respectively). RESULTS: The study enrolled 1200 participants. The ADR in the control, CM-CADe, and SD-CADe groups was 38.3%, 50.0%, and 54.8%, respectively. The pADR was 23.0%, 32.3%, and 38.8%, respectively. AADR was 6.0%, 10.3%, and 9.5%, respectively. After adjustment, the ADR and pADR in both intervention groups were significantly higher than in controls (all P<0.05). The APC in the control, CM-CADe, and SD-CADe groups was 0.66, 1.04, and 1.16, respectively. The pAPC was 0.33, 0.53, and 0.64, respectively, and the AAPC was 0.07, 0.12, and 0.10, respectively. Both CADe systems showed significantly higher APC and pAPC than WLE. AADR and AAPC were improved in both CADe groups versus control, although the differences were not statistically significant. CONCLUSION: Even in high adenoma detectors, CADe significantly improved ADR and APC. The AADR tended to be higher with both systems, and this may enhance colorectal cancer prevention.
背景：本研究旨在评估自行研发的计算机辅助息肉检测系统（SD-CADe）和商用系统（CM-CADe）相较于作为对照的白光内镜检查（WLE）对高腺瘤检出者的益处。 方法：在五个转诊中心接受筛查结肠镜检查的50至75岁平均风险个体被随机分为SD-CADe组、CM-CADe组或WLE组（比例为1:1:1）。招募腺瘤检出率（ADR）≥35%的实习生和工作人员。主要结局为ADR。次要结局为近端腺瘤检出率（pADR）、高级别腺瘤检出率（AADR）以及每次结肠镜检查的腺瘤数量、近端腺瘤数量和高级别腺瘤数量（分别为APC、pAPC和AAPC）。 结果：该研究纳入了1200名参与者。对照组、CM-CADe组和SD-CADe组的ADR分别为38.3%、50.0%和54.8%。pADR分别为23.0%、32.3%和38.8%。AADR分别为6.0%、10.3%和9.5%。调整后，两个干预组的ADR和pADR均显著高于对照组（所有P<0.05）。对照组、CM-CADe组和SD-CADe组的APC分别为0.66、1.04和1.16。pAPC分别为0.33、0.53和0.64，AAPC分别为0.07、0.12和0.10。两种CADe系统的APC和pAPC均显著高于WLE。与对照组相比，两个CADe组的AADR和AAPC均有所改善，尽管差异无统计学意义。 结论：即使在高腺瘤检出者中，CADe也显著提高了ADR和APC。两种系统的AADR均有升高趋势，这可能增强结直肠癌的预防效果。
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