ADOPTION OF A COMPUTER-AIDED DETECTION SYSTEM SIGNIFICANTLY IMPROVES POLYP DETECTION IN ROUTINE CLINICAL PRACTICE

INTRODUCTION: Colonoscopy reduces colorectal cancer mortality via the identification and removal of neoplastic polyps. In clinical trials, computer aided detection (CADe) improves polyp detection, but there is limited data of CADe implementation in routine practice. We aimed to assess the impact of CADe upon polyp detection in a large cohort of high-volume colonoscopists.

METHODS: A CADe system (GI Genius, Medtronic) system was implemented in staggered fashion in a single large academic medical center to pragmatically assess its impact over a 6-month period (March 2022 to August 2022). Four CADe units were placed in a twelve-room endoscopy unit where colonoscopists rotate through different rooms. Thus, a colonoscopist may be able to utilize CADe when performing colonoscopy on one day (“CADe room”) but perform colonoscopy in a room without CADe the next day (“non-CADe room”). Colonoscopists who performed at least 100 colonoscopies over the 6-month period were included in this analysis. Colonoscopists were encouraged but not mandated to utilize CADe. The primary outcome was screening and surveillance colonoscopy polypectomy rate. Secondary outcomes were screening colonoscopy adenoma detection rate (ADR) and serrated detection rate (SDR). Results were further stratified by self-reported utilization of CADe: CADe majority users (self-reported use in > 50% of cases) and CADe minority users (self-reported use in < 50% of cases).

RESULTS: Over the 6-month study period, 21 colonoscopists performed 4,820 colonoscopies (Screening: 2,459, Surveillance: 1,472, and Diagnostic: 889). Of 21 colonoscopists, 9 were CADe majority users. Screening and surveillance polypectomy rates significantly increased in CADe rooms compared to non-CADe rooms (60.5% versus 51.7%, p<0.0001; Table). When stratified by CADe use, CADe majority users had a significant increase in polypectomy rate in CADe compared to non-CADe rooms (66.5% versus 53.4%, p<0.0001); in contrast, CADe minority users did not have a significant increase in polypectomy in CADe compared to non-CADe rooms (54.3% versus 50.4%, p=0.2).
When CADe was available, screening colonoscopy ADR (50.6% versus 41.6%, p<0.0002) and SDR (19.4% versus 14.7%, P=0.006) significantly increased. However, as expected, this significant increase in ADR and SDR was only seen in CADe majority users but not minority users.

DISCUSSION: In this pragmatic assessment of the impact of CADe upon colonoscopy quality, CADe significantly increased polypectomy rates for both screening and surveillance colonoscopy as well as screening colonoscopy ADR and SDR. As the impact of CADe is somewhat blunted by only half of colonoscopists using CADe in a majority of cases, further work is needed to improve CADe utilization in practice.

ACKNOWLEDGEMENTS: Nives and Joseph Rizza and the Digestive Health Foundation for their generous gifts to support AI research.