Integration of Endocuff‐Assisted and Computer‐Aided Colonoscopy: A Meta‐Analysis of Randomized Controlled Trials

TL;DR

Combining AI-assisted colonoscopy with a device called EndoCuff improves detection of colorectal cancer lesions compared to standard methods.

Contribution

This study is the first meta-analysis to evaluate the combined use of AI and EndoCuff in colonoscopy for lesion detection.

Findings

CADe+EAC significantly improved adenoma detection rate compared to standard colonoscopy.

The combination also improved detection of advanced adenomas and sessile serrated lesions.

CADe+EAC reduced withdrawal and insertion times compared to other methods.

Abstract

Colorectal cancer (CRC) is a leading cause of cancer‐related deaths, with missed lesions during colonoscopy contributing to increased mortality. AI‐assisted computer‐aided detection (CADe) systems help reduce adenoma miss rates, and their integration with mucosal exposure devices like EndoCuff vision may enhance detection. This meta‐analysis assesses the effectiveness of combining CADe and EndoCuff vision‐assisted colonoscopy (EAC) compared to standard colonoscopy or CADe alone.

A comprehensive literature search was conducted in MEDLINE, Embase, and clinicaltrials.gov up to November 2024. Only randomized controlled trials (RCTs) comparing CADe+EAC with CADe alone or standard colonoscopy and reporting adenoma detection rate (ADR) were included. Statistical analysis was performed using R version 4.4.0, with mean differences (MDs) and risk ratios (RRs) reported with 95% confidence intervals (CIs).

Four RCTs with 3333 participants were included. Among them, 1228 underwent CADe+EAC, while 554 received standard colonoscopy and 1236 underwent CADe alone. CADe+EAC significantly improved ADR (RR: 1.36; 95% CI: 1.19–1.56), advanced ADR (RR: 1.62; 95% CI: 1.16–2.25), sessile serrated lesion detection rate (RR: 1.95; 95% CI: 1.46–2.61), and mean adenomas per colonoscopy (APC) (MD: 0.50; 95% CI: 0.49–0.52) compared to standard colonoscopy. Compared to CADe alone, CADe+EAC further improved ADR (RR: 1.13; 95% CI: 1.04–1.22) and mean APC (MD: 0.15; 95% CI: 0.07–0.24). However, withdrawal and insertion times were significantly lower in the CADe+EAC group.

The combination of CADe and EAC enhances adenoma detection compared to standard colonoscopy and CADe alone. Further multi‐center trials with diverse AI models are needed to confirm its effectiveness.

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