Introduction: Multiple randomized studies have demonstrated that computer-assisted detection (CADe) improves the colonoscopic adenoma detection rate (ADR); however, these improvements have not been consistently reproduced in some more recent studies.

Methods: Patients aged ≥50 years undergoing outpatient colonoscopy in 12 German institutions were randomized to either the CADe group or the control group. The primary outcome parameter was the adenoma detection rate (ADR), while secondary outcomes included the adenomas per colonoscopy (APC) rate, detection rates of different histologic subgroups, and adverse events. The median examiner-specific observed rates and examiner-adjusted rates were compared between treatment groups.

Results: 1627 patients were included (mean age 63.1 years, 39.8% female; 71.% screening indications). The observed median examiner ADR was 40.0% (inter-quartile range IQR 20.0-57.1%) in the study vs. 37.5% (IQR 20.0-50.0%) in the control group. Similarly, adjusted overall ADR was 40.6 % (95%CI: 35.8%, 45.5%) in the study and 38.3% (95%CI: 33.5%, 43.1%) in the control group. No differences were observed in APC or any of the adenoma subgroups with regards to size, morphology, location, and histology as well as colonoscopy indication. The examiner had a large influence on ADR (adjusted median odds ratio/OR 1.32), similar to patient age (OR per 10-years increase 1.40, 95%CI: 1.23, 1.59) and sex (OR 1.62, 95%CI: 1.30, 2.04). On the other hand, more hyperplastic polyps were found by CADe (OR for adjusted HDR = 1.29; 95% CI: 1.02, 1.63; p=0.033).

Conclusions: In patients over the age of 50 with mixed colonoscopy indications, CADe did not increase the adenoma detection rate. Further studies should define the requirements for selective CADe use in routine clinical practice, particularly in relation to the examiner's baseline ADR.

Copyright © 2025 by The American College of Gastroenterology.

简介： 多项随机研究已证明，计算机辅助检测（CADe）可以提高结肠镜腺瘤检出率（ADR），然而，在一些较近期的研究中并未始终如一地再现这些改善。

方法： 在德国12家医疗机构接受门诊结肠镜检查的50岁及以上患者被随机分配到CADe组或对照组。主要结局指标是腺瘤检出率（ADR），次要结局包括每例结肠镜检查发现的腺瘤数（APC）、不同组织学亚群的检测率以及不良事件。比较了治疗组之间的观察者特定中位值和调整后的比率。

结果： 共纳入1627名患者，平均年龄为63.1岁，女性占39.8%，筛查指征占71%。研究组观察到的中位医生ADR为40.0%（四分位数范围IQR 20.0-57.1%），对照组为37.5%（IQR 20.0-50.0%）。同样，调整后的总体ADR在研究组中为40.6%（95%CI：35.8%，45.5%），在对照组中为38.3%（95%CI：33.5%，43.1%）。没有观察到APC或任何腺瘤亚群的大小、形态、位置和组织学以及结肠镜检查指征方面的差异。医生对ADR有较大影响（调整后的中位数优势比/OR为1.32），类似于患者的年龄（每增加10年OR 1.40，95%CI：1.23，1.59）和性别（OR 1.62，95%CI：1.30，2.04）。另一方面，CADe发现的增生性息肉更多（调整后的HDR OR = 1.29；95% CI：1.02, 1.63；p=0.033）。

结论： 对于年龄超过50岁且具有混合结肠镜检查指征的患者，CADe并未增加腺瘤检出率。进一步的研究应定义选择性CADe在日常临床实践中的使用要求，特别是与医生基线ADR的关系。

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