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Computer-aided detection, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: a randomized controlled trial - 18/02/23

Doi : 10.1016/j.gie.2022.09.023 
Satimai Aniwan, MD 1, 2, Krittaya Mekritthikrai, MD 1, Stephen J. Kerr, PhD 3, Kasenee Tiankanon, MD 1, 2, Kunvadee Vandaungden, MD 1, Yingluk Sritunyarat, MD 1, Panida Piyachaturawat, MD 1, 2, Thanawat Luangsukrerk, MD 4, Santi Kulpatcharapong, MD 1, 2, Naruemon Wisedopas, MD 5, Natanong Kongtub, BSc 1, 2, Pinit Kullavanijaya, MD 1, Rungsun Rerknimitr, MD 1, 2, ⁎
1 Gastrointestinal Endoscopy Excellence Center and Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand 
2 Division of Gastroenterology, Department of Medicine, Bangkok, Thailand 
3 Biostatistics Excellence Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 
4 Division of General Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 
5 Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 

∗Reprint requests: Rungsun Rerknimitr, MD, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.Division of GastroenterologyDepartment of MedicineFaculty of MedicineChulalongkorn UniversityBangkok10330Thailand

Abstract

Background and Aims

Computer-aided detection (CADe) and a mucosal exposure device can improve adenoma detection rate (ADR). Potential benefits of combining the 2 modalities have never been studied. This study aimed to compare ADR differences among CADe alone, endocuff-assisted colonoscopy (EAC) alone, and the combination of CADe and EAC (CADe+EAC) with standard colonoscopy.

Methods

This prospective randomized controlled study included 1245 participants who underwent screening colonoscopy. Participants were randomized to CADe, EAC, CADe+EAC, and standard colonoscopy as a control. The primary outcome was ADR. Secondary outcomes were proximal ADR (pADR), advanced ADR (AADR), and the number of adenomas per colonoscopy (APCs).

Results

ADRs from the control, CADe, EAC, and CADe+EAC groups were 41.9%, 52.2%, 54.0%, and 58.8%, respectively; pADRs were 25.2%, 33.3%, 34.9%, and 37.0%, respectively; AADRs were 7.7%, 8.3%, 8.3%, and 13.6%, respectively; and APCs were .76, 1.11, 1.18, and 1.31, respectively. Significant increases in ADR and pADR were observed between the intervention and control groups (P < .05 in all comparisons). The AADR was significantly higher only in the CADe+EAC group than in the control group (P = .02). The adjusted incidence rate ratios of APCs were significantly higher in the intervention groups versus the control group (P < .01 in all comparisons).

Conclusions

CADe+EAC significantly improve ADR and AADR over standard colonoscopy. However, although CADe or EAC alone can substantially increase the detection of adenomas, they do not lead to increased detection of advanced adenomas unless used in combination. (Clinical trial registration number: TCTR20200929003.)

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Abbreviations : AADR, ADR, APC, CADe, CI, CRC, EAC, IRR, pADR, pAPC


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 DISCLOSURE: All authors disclosed no financial relationships. Research support for this study was provided to Dr. Rungsun Rerknimitr by the National Research Council of Thailand (N42A640330); to Dr. Satimai Aniwan by the Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University (RA65_CRC_003); and Fujifilm (provided CAD EYE).
 DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure gender balance in the recruitment of human subjects. We worked to ensure ethnic or other types of diversity in the recruitment of human subjects. The author list of this paper includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.


© 2023  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 97 - N° 3

P. 507-516 - marzo 2023 Ritorno al numero
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