Effectiveness of artificial intelligence assisted colonoscopy on adenoma and polyp miss rate: A meta-analysis of tandem RCTs.

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-24 DOI:10.1016/j.dld.2024.09.003

M Maida, G Marasco, M H J Maas, D Ramai, M Spadaccini, E Sinagra, A Facciorusso, P D Siersema, C Hassan

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Abstract

Background and aims: One-fourth of colorectal neoplasia is missed at screening colonoscopy, representing the leading cause of interval colorectal cancer (I-CRC). This systematic review and meta-analysis summarizes the efficacy of computer-aided colonoscopy (CAC) compared to white-light colonoscopy (WLC) in reducing lesion miss rates.

Methods: Major databases were systematically searched through May 2024 for tandem-design RCTs comparing lesion miss rates in CAC-first followed by WLC vs WLC-first followed by CAC. The primary outcomes were adenoma miss rate (AMR) and polyp miss rate (PMR). The secondary outcomes were advanced AMR (aAMR) and sessile serrated lesion miss rate (SMR).

Results: Six RCTs (1718 patients) were included. AMR was significantly lower for CAC compared to WLC (RR = 0.46; 95 %CI [0.38-0.55]; P < 0.001). PMR was also lower for CAC compared to WLC (RR = 0.44; 95 %CI [0.33-0.60]; P < 0.001). No significant difference in aAMR (RR = 1.28; 95 %CI [0.34-4.83]; P = 0.71) and SMR (RR = 0.44; 95 %CI [0.15-1.28]; P = 0.13) were observed. Sensitivity analysis including only RCTs performed in CRC screening and surveillance setting confirmed lower AMR (RR = 0.48; 95 %CI [0.39-0.58]; P < 0.001) and PMR (RR = 0.50; 95 %CI [0.37-0.66]; P < 0.001), also showing significantly lower SMR (RR = 0.28; 95 %CI [0.11-0.70]; P = 0.007) for CAC compared to WLC.

Conclusions: CAC results in significantly lower AMR and PMR compared to WLC overall, and significantly lower AMR, PMR and SMR in the screening/surveillance setting, potentially reducing the incidence of I-CRC.

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人工智能辅助结肠镜检查对腺瘤和息肉漏诊率的影响：串联 RCT 的荟萃分析。

背景和目的：四分之一的结直肠肿瘤在结肠镜筛查中被漏诊，这是间歇性结直肠癌（I-CRC）的主要病因。本系统综述和荟萃分析总结了计算机辅助结肠镜检查（CAC）与白光结肠镜检查（WLC）相比在降低病变漏检率方面的功效：方法：系统检索了截至 2024 年 5 月的主要数据库，比较了先 CAC 后 WLC 与先 WLC 后 CAC 的病变漏诊率。主要结果是腺瘤漏诊率（AMR）和息肉漏诊率（PMR）。次要结果是晚期腺瘤漏诊率（aAMR）和无柄锯齿状病变漏诊率（SMR）：结果：共纳入六项 RCT（1718 名患者）。CAC的AMR明显低于WLC（RR = 0.46; 95 %CI [0.38-0.55]; P < 0.001）。与 WLC 相比，CAC 的 PMR 也较低（RR = 0.44；95 %CI [0.33-0.60]；P < 0.001）。aAMR（RR = 1.28；95 %CI [0.34-4.83]；P = 0.71）和SMR（RR = 0.44；95 %CI [0.15-1.28]；P = 0.13）无明显差异。敏感性分析（仅包括在 CRC 筛查和监测环境中进行的 RCT）证实，与 WLC 相比，CAC 的 AMR（RR = 0.48；95 %CI [0.39-0.58]；P < 0.001）和 PMR（RR = 0.50；95 %CI [0.37-0.66]；P < 0.001）更低，SMR（RR = 0.28；95 %CI [0.11-0.70]；P = 0.007）也显著更低：结论：与 WLC 相比，CAC 可明显降低 AMR 和 PMR，而在筛查/监测环境中，CAC 可明显降低 AMR、PMR 和 SMR，从而有可能降低 I-CRC 的发病率。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.