Effect of artificial intelligence-aided colonoscopy on the adenoma detection rate: A systematic review

Colorectal cancer has substantial morbidity and mortality. Approximately one-quarter of cases are overlooked during screening colonoscopy, leading to interval colorectal cancer. The use of artificial intelligence (AI) through deep learning systems has demonstrated promising results in the detection of polyps and adenomas. Consequently, our objective was to evaluate the impact of AI on adenoma detection. To identify relevant studies, we searched the PubMed, MEDLINE, and Cochrane Library databases without restrictions on publication date. Ultimately, we analyzed 16 randomized controlled trials involving 13,685 participants. The primary outcome assessed was the effect of AI-assisted colonoscopy (AIAC) on the adenoma detection rate (ADR). Secondary outcomes included the polyp detection rate (PDR) and adenomas per colonoscopy (APC). A random-effects model was used to calculate pooled effect sizes, and statistical heterogeneity was evaluated using the Higgins I2 statistic, with I2 cutoff points of 25%, 50%, and 75% indicating low, moderate, and high heterogeneity, respectively. Publication bias was investigated using a funnel plot, and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation framework. The findings indicated a 26% greater ADR with AIAC than with standard colonoscopy (40.4% vs. 31.9%). Additionally, AIAC was associated with a 30% greater PDR (52.9% vs. 40.1%) and a 44% higher APC. The findings demonstrate that the integration of AI in colonoscopy improves ADR, PDR, and APC, potentially reducing the incidence of interval colorectal cancer.