Post written by Wai K. Leung, MD, from the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.

A meta-analysis reported that up to 26% of colorectal adenomas could be missed during colonoscopy.

Computer-assisted detection (CADe) has been shown to enhance colorectal adenoma and polyp detection. However, it remains uncertain whether CADe also could reduce the adenoma or polyp miss rate, particularly in the proximal colon where lesions are more often missed.

This multicenter, randomized, tandem-colonoscopy study aimed to determine the proximal colonic miss rate of CADe compared with standard colonoscopy.

Missed lesions are one of the leading causes of postcolonoscopy colorectal cancer development. Therefore, there is a pressing need to reduce the rate of missed lesions. This study characterized the role of CADe in missed lesion reduction.

We enrolled 223 patients from 3 endoscopy centers in Asia. We found no difference in the miss rate for proximal adenomas (CADe vs conventional: 20.0% vs 14.0%, P = .07) and polyps (26.7% vs 19.6%, P = .06).

However, the CADe group had significantly higher proximal polyp (58.0% vs 46.7%, P = .03) and adenoma (44.7% vs 34.6%, P = .04) detection rates than the conventional group. The mean number of proximal polyps and adenomas detected per patient during the first examination also was significantly higher in the CADe group (polyp: 1.20 vs .86, P = .03; adenoma: .91 vs .61, P = .03).

These results further confirm the role of CADe in enhancing proximal colonic lesion detection, but CADe may not be the simple solution to missed proximal lesions during colonoscopy.

Localization box (see green outline) of the computer-assisted detection system.

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