Artificial intelligence for reducing missed detection of adenomas and polyps in colonoscopy: A systematic review and meta-analysis

BACKGROUND Colorectal cancer has a high incidence and mortality rate, and the effectiveness of routine colonoscopy largely depends on the endoscopist’s expertise. In recent years, computer-aided detection (CADe) systems have been increasingly integrated into colonoscopy to improve detection accuracy. However, while most studies have focused on adenoma detection rate (ADR) as the primary outcome, the more sensitive adenoma miss rate (AMR) has been less frequently analyzed. AIM To evaluate the effectiveness of CADe in colonoscopy and assess the advantages of AMR over ADR. METHODS A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials using predefined search strategies to identify relevant studies published up to August 2, 2024. Statistical analyses were performed to compare outcomes between groups, and potential publication bias was assessed using funnel plots. The quality of the included studies was evaluated using the Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Five studies comprising 1624 patients met the inclusion criteria. AMR was significantly lower in the CADe-assisted group than in the routine colonoscopy group (147/927, 15.9% vs 345/960, 35.9%; P < 0.01). However, CADe did not provide a significant advantage in detecting advanced adenomas or lesions measuring 6-9 mm or ≥ 10 mm. The polyp miss rate (PMR) was also lower in the CADe-assisted group [odds ratio (OR), 0.35; 95% confidence interval (CI): 0.23-0.52; P < 0.01]. While the overall ADR did not differ significantly between groups, the ADR during the first-pass examination was higher in the CADe-assisted group (OR, 1.37; 95%CI: 1.10-1.69; P = 0.004). The level of evidence for the included randomized controlled trials was graded as moderate. CONCLUSION CADe can significantly reduce AMR and PMR while improving ADR during initial detection, demonstrating its potential to enhance colonoscopy performance. These findings highlight the value of CADe in improving the detection of colorectal neoplasms, particularly small and histologically distinct adenomas.