Maida M, Marasco G, Maas M H J, Ramai D, Spadaccini M, Sinagra E, Facciorusso A, Siersema P D, Hassan C
Department of Medicine and Surgery, University of Enna 'Kore', Enna, Italy; Gastroenterology Unit, Umberto I Hospital, Enna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy.
Dig Liver Dis. 2025 Jan;57(1):169-175. doi: 10.1016/j.dld.2024.09.003. Epub 2024 Sep 24.
One-fourth of colorectal neoplasia is missed at screening colonoscopy, representing the leading cause of interval colorectal cancer (I-CRC). This systematic review and meta-analysis summarizes the efficacy of computer-aided colonoscopy (CAC) compared to white-light colonoscopy (WLC) in reducing lesion miss rates.
Major databases were systematically searched through May 2024 for tandem-design RCTs comparing lesion miss rates in CAC-first followed by WLC vs WLC-first followed by CAC. The primary outcomes were adenoma miss rate (AMR) and polyp miss rate (PMR). The secondary outcomes were advanced AMR (aAMR) and sessile serrated lesion miss rate (SMR).
Six RCTs (1718 patients) were included. AMR was significantly lower for CAC compared to WLC (RR = 0.46; 95 %CI [0.38-0.55]; P < 0.001). PMR was also lower for CAC compared to WLC (RR = 0.44; 95 %CI [0.33-0.60]; P < 0.001). No significant difference in aAMR (RR = 1.28; 95 %CI [0.34-4.83]; P = 0.71) and SMR (RR = 0.44; 95 %CI [0.15-1.28]; P = 0.13) were observed. Sensitivity analysis including only RCTs performed in CRC screening and surveillance setting confirmed lower AMR (RR = 0.48; 95 %CI [0.39-0.58]; P < 0.001) and PMR (RR = 0.50; 95 %CI [0.37-0.66]; P < 0.001), also showing significantly lower SMR (RR = 0.28; 95 %CI [0.11-0.70]; P = 0.007) for CAC compared to WLC.
CAC results in significantly lower AMR and PMR compared to WLC overall, and significantly lower AMR, PMR and SMR in the screening/surveillance setting, potentially reducing the incidence of I-CRC.
四分之一的结直肠肿瘤在筛查结肠镜检查中被漏诊，这是间隔期结直肠癌（I-CRC）的主要原因。本系统评价和荟萃分析总结了计算机辅助结肠镜检查（CAC）与白光结肠镜检查（WLC）相比在降低病变漏诊率方面的疗效。
系统检索主要数据库至2024年5月，纳入比较先进行CAC再进行WLC与先进行WLC再进行CAC的串联设计随机对照试验（RCT）。主要结局为腺瘤漏诊率（AMR）和息肉漏诊率（PMR）。次要结局为高级别腺瘤漏诊率（aAMR）和无蒂锯齿状病变漏诊率（SMR）。
纳入6项RCT（1718例患者）。与WLC相比，CAC的AMR显著更低（RR = 0.46；95%CI [0.38-0.55]；P < 0.001）。与WLC相比，CAC的PMR也更低（RR = 0.44；95%CI [0.33-0.60]；P < 0.001）。未观察到aAMR（RR = 1.28；95%CI [0.34-4.83]；P = 0.71）和SMR（RR = 0.44；95%CI [0.15-1.28]；P = 0.13）有显著差异。仅纳入在CRC筛查和监测环境中进行的RCTs的敏感性分析证实，与WLC相比，CAC的AMR（RR = 0.48；95%CI [0.39-0.58]；P < 0.001）和PMR（RR = 0.50；95%CI [0.37-0.66]；P < 0.001）更低，且SMR也显著更低（RR = 0.28；95%CI [0.11-0.70]；P = 0.007）。
总体而言，与WLC相比，CAC导致显著更低的AMR和PMR，在筛查/监测环境中导致显著更低的AMR、PMR和SMR，可能降低I-CRC的发病率。
