Alali Ali A, Alhashmi Ahmad, Alotaibi Nawal, Ali Nargess, Alali Maryam, Alfadhli Ahmad
Department of Medicine, Faculty of Medicine, Kuwait University, Jabriyah 13110, Kuwait.
Thunayan Alghanim Gastroenterology Center, Amiri Hospital, Sharq 15300, Kuwait.
J Clin Med. 2025 Jan 17;14(2):581. doi: 10.3390/jcm14020581.
Colorectal cancer (CRC) is the second leading cause of cancer death in Kuwait. The effectiveness of colonoscopy in preventing CRC is dependent on a high adenoma detection rate (ADR). Computer-aided detection can identify (CADe) and characterize polyps in real time and differentiate benign from neoplastic polyps, but its role remains unclear in screening colonoscopy. This was a randomized-controlled trial (RCT) enrolling patients 45 years of age or older presenting for outpatient screening or surveillance colonoscopy (Kuwait clinical trial registration number 2047/2022). Patients with a history of inflammatory bowel disease, alarm symptoms, familial polyposis syndrome, colon resection, or poor bowel preparation were excluded. Patients were randomly assigned to either high-definition white-light (HD-WL) colonoscopy (standard of care) or HD-WL colonoscopy with the CADe system. The primary outcome was ADR. The secondary outcomes included polyp detection rate (PDR), adenoma per colonoscopy (APC), polyp per colonoscopy (PPC), and accuracy of polyp characterization. From 1 September 2022 to 1 March 2023, 102 patients were included and allocated to either the HD-WL colonoscopy group (n = 51) or CADe group (n = 51). The mean age was 52.8 years (SD 8.2), and males represented 50% of the cohort. Screening for CRC accounted for 94.1% of all examinations, while the remaining patients underwent surveillance colonoscopy. A total of 121 polyps were detected with an average size of 4.18 mm (SD 5.1), the majority being tubular adenomas with low-grade dysplasia (47.1%) and hyperplastic polyps (46.3%). There was no difference in the overall bowel preparation, insertion and withdrawal times, and adverse events between the two arms. ADR (primary outcome) was non-significantly higher in the CADe group compared to the HD colonoscopy group (47.1% vs. 37.3%, = 0.3). Among the secondary outcomes, PDR (78.4% vs. 56.8%, = 0.02) and PPC (1.35 vs. 0.96, = 0.04) were significantly higher in the CADe group, but APC was not (0.75 vs. 0.51, = 0.09). Accuracy in characterizing polyp histology was similar in both groups. In this RCT, the artificial intelligence system showed a non-significant trend towards improving ADR among Kuwaiti patients undergoing screening or surveillance colonoscopy compared to HD-WL colonoscopy alone, while it significantly improved the detection of diminutive polyps. A larger multicenter study is required to detect the true effect of CADe on the detection of adenomas.
结直肠癌（CRC）是科威特癌症死亡的第二大主要原因。结肠镜检查预防CRC的有效性取决于高腺瘤检出率（ADR）。计算机辅助检测（CADe）可以实时识别和表征息肉，并区分良性和肿瘤性息肉，但其在筛查结肠镜检查中的作用仍不明确。这是一项随机对照试验（RCT），纳入年龄在45岁及以上的门诊筛查或监测结肠镜检查患者（科威特临床试验注册号2047/2022）。排除有炎症性肠病病史、报警症状、家族性息肉病综合征、结肠切除术或肠道准备不佳的患者。患者被随机分配到高清白光（HD-WL）结肠镜检查（护理标准）组或配备CADe系统的HD-WL结肠镜检查组。主要结局是ADR。次要结局包括息肉检出率（PDR）、每次结肠镜检查的腺瘤数（APC）、每次结肠镜检查的息肉数（PPC）以及息肉表征的准确性。从2022年9月1日至2023年3月1日，共纳入102例患者，并分配到HD-WL结肠镜检查组（n = 51）或CADe组（n = 51）。平均年龄为52.8岁（标准差8.2），男性占队列的50%。CRC筛查占所有检查的94.1%，其余患者接受监测结肠镜检查。共检测到121个息肉，平均大小为4.18毫米（标准差5.1），大多数为低级别发育异常的管状腺瘤（47.1%）和增生性息肉（46.3%）。两组在总体肠道准备、插入和退出时间以及不良事件方面无差异。与HD结肠镜检查组相比，CADe组的ADR（主要结局）略高，但无统计学意义（47.1%对37.3%，P = 0.3）。在次要结局中，CADe组的PDR（78.4%对56.8%，P = 0.02）和PPC（1.35对0.96，P = 0.04）显著更高，但APC无显著差异（0.75对0.51，P = 0.09）。两组在息肉组织学表征的准确性方面相似。在这项RCT中，与单独的HD-WL结肠镜检查相比，人工智能系统在接受筛查或监测结肠镜检查的科威特患者中显示出ADR改善的趋势，但无统计学意义，同时它显著提高了微小息肉的检出率。需要进行更大规模的多中心研究来检测CADe对腺瘤检测的真实效果。
