Improvement in adenoma detection rate by artificial intelligence-assisted colonoscopy: Multicenter quasi-randomized controlled trial

Background and study aims Adenoma detection rate (ADR) is a key performance measure with variability among endoscopists. Artificial intelligence (AI) in colonoscopy could reduce this variability and has shown to improve ADR. This study assessed the impact of AI on ADR among Danish endoscopists of varying experience levels. Patients and methods We conducted a prospective, quasi-randomized, controlled, multicenter trial involving patients aged 18 and older undergoing screening, surveillance, and diagnostic colonoscopy at four centers. Participants were assigned to AI-assisted colonoscopy (GI Genius, Medtronic) or conventional colonoscopy. Endoscopists were classified as experts (> 1000 colonoscopies) or non-experts (<= 1000 colonoscopies). The primary outcome was ADR. We performed a subgroup analysis stratified on endoscopist experience and a subset analysis of the screening population. Results A total of 795 patients were analyzed: 400 in the AI group and 395 in the control group. The AI group demonstrated a significantly higher ADR than the control group (59.1% vs. 46.6%, P < 0.001). The increase was significant among experts (59.9% vs. 47.3%, P < 0.002) but not among non-experts. AI assistance significantly improved ADR (74.4% vs. 58.1%, P = 0.003) in screening colonoscopies. Polyp detection rate (PDR) was also higher in the AI group (69.8% vs. 56.2%, P < 0.001). There was no significant difference in the non-neoplastic resection rate (NNRR) (15.1% vs. 17.1%, P = 0.542). Conclusions AI-assisted colonoscopy significantly increased ADR by 12.5% overall, with a notable 16.3% increase in the screening population. The unchanged NNRR indicates that the higher PDR was due to increased ADR, not unnecessary resections.