Soleymanjahi Saeed, Huebner Jack, Elmansy Lina, Rajashekar Niroop, Lüdtke Nando, Paracha Rumzah, Thompson Rachel, Grimshaw Alyssa A, Foroutan Farid, Sultan Shahnaz, Shung Dennis L
Division of Gastroenterology, Mass General Brigham, Harvard School of Medicine, Boston, Massachusetts (S.Soleymanjahi).
Department of Medicine, Yale School of Medicine, New Haven, Connecticut (J.H., L.E., N.R., R.P., R.T.).
Ann Intern Med. 2024 Dec;177(12):1652-1663. doi: 10.7326/ANNALS-24-00981. Epub 2024 Oct 22.
Randomized clinical trials (RCTs) of computer-aided detection (CADe) system-enhanced colonoscopy compared with conventional colonoscopy suggest increased adenoma detection rate (ADR) and decreased adenoma miss rate (AMR), but the effect on detection of advanced colorectal neoplasia (ACN) is unclear.
To conduct a systematic review to compare performance of CADe-enhanced and conventional colonoscopy.
Cochrane Library, Google Scholar, Ovid EMBASE, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection databases were searched through February 2024.
Published RCTs comparing CADe-enhanced and conventional colonoscopy.
Average adenoma per colonoscopy (APC) and ACN per colonoscopy were primary outcomes. Adenoma detection rate, AMR, and ACN detection rate (ACN DR) were secondary outcomes. Balancing outcomes included withdrawal time and resection of nonneoplastic polyps (NNPs). Subgroup analyses were done by neural network architecture.
Forty-four RCTs with 36 201 cases were included. Computer-aided detection-enhanced colonoscopies have higher average APC (12 090 of 12 279 [0.98] vs. 9690 of 12 292 [0.78], incidence rate difference [IRD] = 0.22 [95% CI, 0.16 to 0.28]) and higher ADR (7098 of 16 253 [44.7%] vs. 5825 of 15 855 [36.7%], rate ratio [RR] = 1.21 [CI, 1.15 to 1.28]). Average ACN per colonoscopy was similar (1512 of 9296 [0.16] vs. 1392 of 9121 [0.15], IRD = 0.01 [CI, -0.01 to 0.02]), but ACN DR was higher with CADe system use (1260 of 9899 [12.7%] vs. 1119 of 9746 [11.5%], RR = 1.16 [CI, 1.02 to 1.32]). Using CADe systems resulted in resection of almost 2 extra NNPs per 10 colonoscopies and longer total withdrawal time (0.53 minutes [CI, 0.30 to 0.77]).
Statistically significant heterogeneity in quality and sample size and inability to blind endoscopists to the intervention in included studies may affect the performance estimates.
Computer-aided detection-enhanced colonoscopies have increased APC and detection rate but no difference in ACN per colonoscopy and a small increase in ACN DR. There is minimal increase in procedure time and no difference in performance across neural network architectures.
None. (PROSPERO: CRD42023422835).
与传统结肠镜检查相比，计算机辅助检测（CADe）系统增强型结肠镜检查的随机临床试验表明腺瘤检出率（ADR）增加，腺瘤漏诊率（AMR）降低，但对晚期结直肠肿瘤（ACN）检测的影响尚不清楚。
进行一项系统评价，以比较CADe增强型和传统结肠镜检查的性能。
检索Cochrane图书馆、谷歌学术、Ovid EMBASE、Ovid MEDLINE、PubMed、Scopus和Web of Science核心合集数据库至2024年2月。
发表的比较CADe增强型和传统结肠镜检查的随机对照试验。
每次结肠镜检查的平均腺瘤数（APC）和每次结肠镜检查的ACN为主要结局。腺瘤检出率、AMR和ACN检出率（ACN DR）为次要结局。平衡结局包括退镜时间和非肿瘤性息肉（NNP）切除情况。按神经网络结构进行亚组分析。
纳入44项随机对照试验，共36201例患者。CADe增强型结肠镜检查的平均APC更高（12279例中的12090例[0.98]对12292例中的9690例[0.78]，发病率差异[IRD]=0.22[95%CI，0.16至0.28]），ADR更高（16253例中的7098例[44.7%]对15855例中的5825例[36.
