Lack of Effectiveness of Computer Aided Detection for Colorectal Neoplasia: A Systematic Review and Meta-Analysis of Nonrandomized Studies

Benefits of computer-aided detection (CADe) in detecting colorectal neoplasia were shown in many randomized trials where endoscopists' behavior was strictly controlled. However, the effect of CADe on endoscopists' performance in less-controlled setting is unclear. This systematic review and meta-analyses were aimed at clarifying benefits and harms of using CADe in real-world colonoscopy.We searched MEDLINE, EMBASE, Cochrane and Google Scholar from inception to August 20, 2023. We included non-randomized studies that compared the effectiveness between CADe-assisted and standard colonoscopy. Two investigators independently extracted study data and quality. Pairwise meta-analysis was performed utilizing Risk ratio (RR) for dichotomous variables and mean difference (MD) for continuous variables with a 95% confidence interval (95% CI).Eight studies were included, comprising 9,782 patients (4569 with CADe and 5213 without CADe). Regarding benefits, there was neither a difference in adenoma detection rate (44% vs 38%; RR 1.11 [95% CI 0.97 - 1.28]) nor mean adenoma per colonoscopy (0.93 vs 0.79; MD 0.14 [-0.04 - 0.32]) between the CADe-assisted and standard colonoscopy, respectively. Regarding harms, there was no difference in the mean non-neoplastic lesions per colonoscopy (8 studies included for analysis, 0.52 vs 0.47; MD 0.14 [95% CI -0.07 - 0.34]) and withdrawal time (6 studies included for analysis, 14.3 vs 13.4 minutes; MD 0.8 minutes [95% CI -0.18 - 1.90]). There was a substantial heterogeneity, and all outcomes were graded with a very low certainty of evidence.CADe in colonoscopies neither improves the detection of colorectal neoplasia nor increases burden of colonoscopy in real-world, non-randomized studies, questioning the generalizability of the results of randomized trials.