S409 Comparing Adenoma Detection Rate Between Computer-Aided Detection and Water Exchange Colonoscopy Using Pooled RCTs Data – An Interim Report

Introduction: Adenoma detection rate (ADR) is inversely correlated with interval cancer and is an important quality indicator in colonoscopy. Water exchange (WE) colonoscopy has consistently improved adenoma detection in multiple randomized controlled trials. Advance in artificial intelligence has enabled computer-aided detection (CADe) of lesions during colonoscopy. CADe has been shown to improve adenoma detection. In our study, we aimed to compare the ADR of WE and CADe using conventional colonoscopy as the common comparator. Methods: The literature was searched for randomized controlled trials (RCTs) comparing either WE or CADe with conventional colonoscopy and reported ADR as an outcome. The keywords colonoscopy, water exchange, computer-aided detection, artificial intelligence, and adenoma detection were used in the search. Data from the RCTs were extracted and pooled. We compared the ADR of CADe and WE with conventional colonoscopy using the chi-square test. Results: We identified 278 articles in the initial keyword search. A total of 32 RCTs, including 14 on WE and 18 on CADe were included in the analysis. In the first cohort, 8,047 patients underwent either WE or conventional colonoscopy. WE significantly improved ADR compared to conventional colonoscopy (35.4 vs 28.9, P< 0.01). In the second cohort, 14,942 patients underwent either CADe or conventional colonoscopy. The ADR for CADe was significantly higher than conventional colonoscopy (39.8 vs 31.7, P< 0.01). The combined ADR for conventional colonoscopy was 30.6. Compared to the combined conventional colonoscopy, WE significantly improved ADR by 4.8% (P< 0.01) and CADe significantly improved ADR by 9% (P< 0.01). Conclusion: In this interim analysis, both WE and CADe significantly improved ADR compared with conventional colonoscopy. CADe appeared to have higher ADR than WE. However, the RCTs examining CADe had higher ADR for their control group compared with the control group in WE RCTs. Future report will utilitze meta-analysis with random effect model to account for population heterogeneity and adjust for co-variables to better elucidate the real difference in ADR between WE and CADe (Table 1). Table 1. - Randomized Controlled Trials Comparing Adenoma Detection Rate of Water Exchange or Computer Aided Detection Colonoscopy with Conventional Colonoscopy Author, year Countries Number of centers Type Sample size Male percentage Mean age Indication Mean withdrawal time (min) Mean Boston bowel preparation score ADR Hsieh, 2014 Taiwan 1 Conventional 90 66.7 56.5 Screening, Surveillance, Diagnostic 10.7 6.1 43.3 Hsieh, 2014 Taiwan 1 WE 90 61.1 56.9 Screening, Surveillance, Diagnostic 11.7 6.8 56.7 Hsieh, 2017 Taiwan 2 Conventional 217 48.4 54.8 Screening, Surveillance, Diagnostic 13.0 6.2 38.1 Hsieh, 2017 Taiwan 2 WE 217 55.8 55.7 Screening, Surveillance, Diagnostic 13.1 7.1 51.0 Leung, 2010 USA 1 Conventional 40 66.8 Screening, Surveillance, Diagnostic 19.0 23.0 Leung, 2010 USA 1 WE 42 66.0 Screening, Surveillance, Diagnostic 22.0 36.0 Cadoni, 2014 Italy 2 Conventional 334 61.1 60.0 Screening, Surveillance, Diagnostic 9.0 19.2 Cadoni, 2014 Italy 2 WE 338 60.0 58.0 Screening, Surveillance, Diagnostic 10.0 25.8 Arai, 2016 Japan 2 Conventional 197 61.9 63.1 Screening, Surveillance, Diagnostic 10.5 57.9 Arai, 2016 Japan 2 WE 206 60.7 65.6 Screening, Surveillance, Diagnostic 11.3 67.5 Leung, 2019 USA 1 Conventional 159 91.2 60.8 Screening 18.4 61.6 Leung, 2019 USA 1 WE 161 85.7 60.5 Screening 18.7 61.5 Cadoni, 2016 Italy and Czech Republic 3 Conventional 239 100.0 59.0 Screening, Surveillance, Diagnostic 12.7 7.2 36.8 Cadoni, 2016 Italy and Czech Republic 3 WE 232 100.0 60.0 Screening, Surveillance, Diagnostic 12.9 7.8 40.9 Jia, 2017 China 6 Conventional 1650 51.8 50.3 Screening, Surveillance, Diagnostic 7.4 7.0 13.4 Jia, 2017 China 6 WE 1653 50.2 50.3 Screening, Surveillance, Diagnostic 7.3 7.3 18.3 Garborg, 2015 Norway and Poland 2 Conventional 239 50.6 61.0 Screening, Diagnostic 13.0 7.3 31.0 Garborg, 2015 Norway and Poland 2 WE 234 51.3 60.0 Screening, Diagnostic 15.0 7.3 35.0 Azevedo, 2018 Portugal 1 Conventional 71 56.3 63.6 Screening, Surveillance, Diagnostic 11.7 7.5 28.2 Azevedo, 2018 Portugal 1 WE 70 58.6 61.6 Screening, Surveillance, Diagnostic 11.3 7.8 31.4 Tseng, 2022 Taiwan 1 Conventional 140 48.6 59.7 Screening, Surveillance, Diagnostic 12.4 7.3 54.7 Tseng, 2022 Taiwan 1 WE 144 52.1 58.9 Screening, Surveillance, Diagnostic 11.8 8.2 63.2 Ramirez, 2011 USA 1 Conventional 191 96.3 59.3 Screening 13.7 46.1 Ramirez, 2011 USA 1 WE 177 96.6 60.0 Screening 12.9 57.1 Leung, 2013 USA 1 Conventional 50 94.0 60.0 Screening 16.0 48.0 Leung, 2013 USA 1 WE 50 100.0 61.0 Screening 16.0 54.0 Cadoni, 2017 Italy and Czech Republic 3 Conventional 408 55.1 60.9 Screening, Diagnostic 8.3 7.7 40.4 Cadoni, 2017 Italy and Czech Republic 3 WE 408 54.9 61.4 Screening, Diagnostic 8.7 8.3 49.3 Su, 2020 China 1 Conventional 315 47.0 51.6 Screening, Surveillance, Diagnostic 5.7 80.6 16.5 Su, 2020 China 1 CADe 308 51.6 50.5 Screening, Surveillance, Diagnostic 7.0 87.3 28.9 Gong, 2020 China 1 Conventional 349 45.0 48.3 Screening, Surveillance, Diagnostic 4.8 6.0 8.0 Gong, 2020 China 1 CADe 355 53.0 47.3 Screening, Surveillance, Diagnostic 6.4 6.0 16.0 Wang, 2020 China 1 Conventional 478 53.0 48.4 Screening, Diagnostic 6.4 7.0 28.0 Wang, 2020 China 1 CADe 484 50.0 49.3 Screening, Diagnostic 6.5 6.8 34.0 Liu, 2019 China 1 Conventional 518 55.4 50.1 Screening, Diagnostic 6.7 6.7 23.9 Liu, 2019 China 1 CADe 508 52.0 51.0 Screening, Diagnostic 6.8 6.7 39.1 Wang, 2019 China 1 Conventional 536 46.5 49.9 Screening, Diagnostic 6.1 14.7 20.3 Wang, 2019 China 1 CADe 522 30.4 51.1 Screening, Diagnostic 6.2 14.0 29.1 Repici, 2020 Italy 3 Conventional 344 49.6 61.1 Screening, Surveillance, Diagnostic 7.3 7.4 40.4 Repici, 2020 Italy 3 CADe 341 50.4 61.5 Screening, Surveillance, Diagnostic 7.0 7.4 54.8 Repici, 2022 Italy and Switzerland 5 Conventional 330 47.3 62.2 Screening, Surveillance, Diagnostic 8.9 7.5 44.5 Repici, 2022 Italy and Switzerland 5 CADe 330 52.7 61.9 Screening, Surveillance, Diagnostic 8.2 7.4 53.3 Wang, 2020 China 1 Conventional 185 49.5 47.2 Screening, Surveillance, Diagnostic 7.2 26.5 Wang, 2020 China 1 CADe 184 50.5 47.7 Screening, Surveillance, Diagnostic 7.1 34.8 Xu, 2023 China and Hong Kong 6 Conventional 1540 47.3 57.0 Screening, Diagnostic 8.4 7.0 32.4 Xu, 2023 China and Hong Kong 6 CADe 1519 46.5 57.5 Screening, Diagnostic 9.0 7.0 39.9 Yao, 2022 China 1 Conventional 271 42.1 50.9 Screening, Surveillance, Diagnostic 9.4 85.2 14.8 Yao, 2022 China 1 CADe 268 45.2 50.7 Screening, Surveillance, Diagnostic 9.9 84.7 21.3 Liu, 2020 China 1 Conventional 397 48.9 48.8 Screening, Diagnostic 6.6 6.7 20.9 Liu, 2020 China 1 CADe 420 45.8 49.8 Screening, Diagnostic 6.4 6.7 29.0 Shaukat, 2022 USA 5 Conventional 677 47.6 59.9 Screening, Surveillance 8.4 8.3 43.9 Shaukat, 2022 USA 5 CADe 682 46.0 60.8 Screening, Surveillance 8.9 8.3 47.8 Aniwan, 2023 Thailand 1 Conventional 310 42.9 62.0 Screening, Diagnostic 9.2 8.2 41.9 Aniwan, 2023 Thailand 1 CADe 312 42.6 62.8 Screening, Diagnostic 9.5 8.1 52.2 Brown, 2022 USA 4 Conventional 110 61.8 60.5 Screening, Surveillance 7.3 8.7 43.6 Brown, 2022 USA 4 CADe 113 47.8 61.2 Screening, Surveillance 9.2 8.7 50.4 Wei, 2023 USA 4 Conventional 382 51.2 57.6 Screening, Surveillance 10.7 37.2 Wei, 2023 USA 4 CADe 387 50.8 58.0 Screening, Surveillance 11.7 35.9 Gimeno-Garcia, 2023 Spain 1 Conventional 157 52.9 64.7 Screening, Surveillance, Diagnostic 7.8 7.2 44.6 Gimeno-Garcia, 2023 Spain 1 CADe 155 52.9 63.0 Screening, Surveillance, Diagnostic 8.0 7.4 56.8 Kamba, 2021 Japan 4 Conventional 177 76.8 61.4 Screening, Surveillance, Diagnostic 7.5 53.6 Kamba, 2021 Japan 4 CADe 178 76.4 61.6 Screening, Surveillance, Diagnostic 7.2 64.5 Rondonotti, 2022 Italy 5 Conventional 395 49.6 61.0 Diagnostic 8.9 45.3 Rondonotti, 2022 Italy 5 CADe 405 52.6 62.0 Diagnostic 9.3 53.6 CADe, computer-aided detection; ADR, adenoma detection rate; WE, water exchange