Efficacy of artificial intelligence for adenoma detection in water exchange colonoscopy: a two-center randomized controlled trial

Chi-Liang Cheng; Sergio Cadoni; Paolo Gallittu; Donatella Mura; Erika Utzeri; Yen-Lin Kuo; I-Chia Su; Yun-Shien Lee; Zi-Wei Chen; William Y. Cheng; Yi-Ning Tsui; Bai-Ping Lee; Cesare Hassan; Felix W. Leung

doi:10.1055/a-2681-5544

Endoscopy, Table of Contents

Endoscopy
DOI: 10.1055/a-2681-5544

Original article

Efficacy of artificial intelligence for adenoma detection in water exchange colonoscopy: a two-center randomized controlled trial

Chi-Liang Cheng

¹Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan, Taiwan

,

Sergio Cadoni

²Digestive Endoscopy Unit, CTO Hosptital, Iglesias, Italy

,

Paolo Gallittu

²Digestive Endoscopy Unit, CTO Hosptital, Iglesias, Italy

,

Donatella Mura

²Digestive Endoscopy Unit, CTO Hosptital, Iglesias, Italy

,

Erika Utzeri

²Digestive Endoscopy Unit, CTO Hosptital, Iglesias, Italy

,

Yen-Lin Kuo

¹Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan, Taiwan

,

I-Chia Su

¹Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan, Taiwan

,

Yun-Shien Lee

³Department of Biotechnology, School of Health Technology, Ming Chuan University, Taoyuan, Taiwan

,

Zi-Wei Chen

³Department of Biotechnology, School of Health Technology, Ming Chuan University, Taoyuan, Taiwan

,

William Y. Cheng

⁴Medicine, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

,

Yi-Ning Tsui

¹Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan, Taiwan

,

Bai-Ping Lee

¹Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, Taoyuan, Taiwan

,

Cesare Hassan

⁵Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)

⁶Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)

,

Felix W. Leung

⁷Division of Gastroenterology, Department of Medicine, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS), North Hills, California, United States

⁸David Geffen School of Medicine at UCLA, Los Angeles, California, United States

› Author Affiliations

Abstract

Background

Water exchange and artificial intelligence-based computer-aided detection (CADe) separately improve the adenoma detection rate (ADR) and number of adenomas detected per colonoscopy (APC). We aimed to determine whether combining water exchange with CADe enhanced APC versus water exchange alone.

Methods

This randomized controlled trial was conducted at hospitals in Italy and Taiwan using different CADe devices. Patients aged 45–75 years undergoing colonoscopy for screening, surveillance, or positive fecal blood tests were randomized to either water exchange with CADe assistance or water exchange alone. The primary outcome was APC, with 752 patients planned for randomization.

Results

An interim analysis was conducted on 560 patients (75% of the enrollment target; mean age 59.4 years; male 299; water exchange+CADe 279), with similar baseline characteristics between the two groups. APC was significantly higher with water exchange+CADe compared with water exchange alone (1.39 [95%CI 1.06–1.72] vs. 1.05 [95%CI 0.87–1.23]) with an incidence rate ratio of 1.32 (95%CI 1.14–1.54), representing an absolute increase of 0.34. The observed significant difference led to early trial termination. No significant differences were found in ADR and sessile serrated lesion detection rates between the groups (54.1% vs. 50.2% [P = 0.35] and 3.6% vs. 3.6% [P = 0.99], respectively), but this study was not powered to detect such differences. Withdrawal times and the mean number of non-neoplastic lesions per colonoscopy were comparable.

Conclusions

For water exchange colonoscopy, integrating CADe statistically increased APC without prolonging withdrawal times or causing a concomitant increase in resection of non-neoplastic lesions.

Full Text

References

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Supplementary Material

Supplementary Material