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CADe Systems Show Variable Improvements in Adenoma Detection During Colonoscopy in Meta-AnalysisAI tools help doctors spot more colon polyps during routine colonoscopies

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Key Takeaway
Consider CADe systems as a variable adjunct for improving adenoma detection, but note the low-to-moderate certainty of evidence.

This systematic review and network meta-analysis synthesized evidence from 48 randomized controlled trials (RCTs) involving a total of 38,986 patients undergoing colonoscopy. The specific clinical setting was not reported. The analysis aimed to compare the performance of different artificial intelligence-based computer-aided detection (CADe) systems for colorectal polyp detection. The population consisted of patients undergoing colonoscopy, though specific inclusion or exclusion criteria for the underlying trials were not detailed in the provided data.

The intervention was colonoscopy performed with one of three CADe systems: ENDO-AID, CADEYE, or GI Genius. The comparator was standard colonoscopy performed without any CADe assistance. The specific procedural protocols, including bowel preparation standards or endoscopist experience levels, were not reported. The analysis treated each CADe system as a distinct node in a network meta-analysis to allow for indirect comparisons between them, with all systems compared against the common control of standard colonoscopy.

The primary outcome was the adenoma detection rate (ADR). All three CADe systems showed improved ADR compared to controls. For the ENDO-AID system, the risk ratio (RR) was 1.26 (95% credible interval [CrI] 1.14 to 1.40). For the CADEYE system, the RR was 1.18 (95% CrI 1.10 to 1.26). For the GI Genius system, the RR was 1.15 (95% CrI 1.08 to 1.22). The credible intervals for all systems did not cross 1.0, indicating statistical significance. Absolute numbers for ADR in each group were not reported, limiting the interpretation of the clinical magnitude of benefit.

A key secondary outcome was the sessile serrated lesion detection rate (SSLDR). Data for this outcome were available for only two systems. The ENDO-AID system showed an RR of 1.36 (95% CrI 1.03 to 1.79) for SSLDR compared to control. The GI Genius system showed an RR of 1.25 (95% CrI 1.08 to 1.46). The CADEYE system's performance for SSLDR was not reported. As with the primary outcome, absolute detection rates were not provided.

No safety or tolerability findings were reported in this meta-analysis. Rates of adverse events, serious adverse events, procedural complications, or study discontinuations were not provided. The analysis focused solely on efficacy outcomes (detection rates), leaving a gap in the understanding of the risk profile associated with implementing these CADe systems in routine practice.

These results align with and extend the findings of prior individual RCTs and meta-analyses that have generally shown a benefit for CADe in improving ADR. The novel contribution of this network meta-analysis is the head-to-head comparison suggesting variable effect sizes between different commercially available systems, with ENDO-AID appearing to have the largest point estimate for ADR improvement. However, the overlapping credible intervals indicate that these differences between systems may not be statistically significant.

Key methodological limitations must be considered. The certainty of the evidence, as assessed by the CINeMA framework, ranged from low to moderate. The analysis did not report on several important limitations common to meta-analyses, such as heterogeneity between included trials, publication bias, or the quality of individual RCTs. The lack of absolute outcome numbers limits the ability to calculate the number needed to treat to find one additional adenoma. Furthermore, the analysis does not address whether improved detection translates into improved long-term clinical outcomes, such as reduced colorectal cancer incidence or mortality.

The clinical implications are that CADe systems represent a promising adjunct technology that may enhance the quality of colonoscopy. The finding of variable effect sizes suggests that not all AI systems may be equivalent, though direct comparative trials are needed to confirm this. For practices considering adoption, the choice may depend on factors beyond efficacy, including cost, integration with existing endoscopy platforms, and real-world usability, none of which were addressed here. The improvement in SSLDR for some systems is particularly noteworthy given the challenges in visually identifying these lesions.

Significant questions remain unanswered. The long-term impact of increased adenoma detection on cancer prevention is unknown. The cost-effectiveness of implementing these systems has not been established. The performance in specific high-risk subgroups or in the hands of endoscopists with varying baseline ADRs is unclear. Finally, whether the use of CADe leads to increased resection of non-neoplastic lesions (increased false positives) or unnecessarily prolongs procedure time was not reported and requires investigation.

If you've ever had a colonoscopy or know someone who has, you understand the anxiety around the procedure. The goal is simple: find and remove polyps before they can turn into cancer. But doctors are human, and some polyps—especially small, flat ones—can be easy to miss. This research matters because it examines whether new artificial intelligence (AI) tools, acting as a second set of eyes, can help doctors do a more thorough job. For anyone facing a colonoscopy, better detection could mean a lower chance of a missed polyp and potentially greater peace of mind.

The researchers didn't conduct a new experiment. Instead, they performed what's called a systematic review and network meta-analysis. Think of it as a massive research roundup. They gathered and combined the results from 48 different randomized controlled trials, which are considered the gold standard for medical evidence. In total, they looked at data from 38,986 patients who underwent colonoscopy. They specifically compared colonoscopies done with the help of three different AI computer-aided detection (CADe) systems—ENDO-AID, CADEYE, and GI Genius—against standard colonoscopies done without any AI assistance.

What did they find? The AI systems helped. When doctors used the AI tools, they found more adenomas, which are the type of polyps most likely to become cancerous. The improvement wasn't the same for every system. The tool called ENDO-AID was linked to the biggest boost, followed by CADEYE, and then GI Genius. In statistical terms, using ENDO-AID meant patients were about 26% more likely to have an adenoma found compared to standard colonoscopy. For CADEYE it was about 18% more likely, and for GI Genius about 15% more likely. The researchers also looked at a trickier type of polyp called sessile serrated lesions, which are flatter and harder to see. They found hints that ENDO-AID and GI Genius might help doctors spot more of these as well, but the evidence here was less clear.

An important note is that the study did not report on safety. We don't know from this analysis if using these AI systems led to any more complications, discomfort, or problems during the procedures. The original trials likely monitored for safety, but this particular review didn't compile or highlight those results.

It's crucial not to get overly excited by these numbers. The researchers themselves graded the certainty of this evidence as ranging from 'low' to 'moderate.' This means we should have a fair amount of confidence, but not absolute certainty, in these findings. The results are also based on 'relative risk'—a comparison of likelihoods—and the study doesn't tell us the actual number of extra polyps found per 100 patients. Furthermore, this was a network meta-analysis, which is a complex way of comparing multiple treatments indirectly. It's powerful, but it's not as straightforward as a single, head-to-head trial.

So, what does this mean for you or a loved one scheduling a colonoscopy right now? It realistically means that AI assistance during the procedure is a promising development that is being actively studied. If your doctor's clinic uses one of these systems, it might offer a small edge in finding polyps. However, it is not a magic bullet. The most important factors for a successful colonoscopy remain having a skilled, careful doctor and a well-prepared colon. You should not panic or feel your past colonoscopy was inadequate if it was done without AI. This research adds one more piece to the puzzle of how to make cancer prevention even better, but the foundation—getting screened on time—is what truly saves lives.

What this means for you:
AI may help doctors find more colon polyps, but the evidence certainty is not yet high.

Study Details

Study typeMeta analysis
Sample sizen = 38,986
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
BACKGROUND AND AIMS: Computer-aided detection (CADe) is anticipated to enhance adenoma detection rate (ADRs). The aim of this study was to systematically collect randomized-controlled trials comparing colonoscopy with CADe to standard colonoscopy without CADe in ADRs. METHODS: We performed a Bayesian network meta-analysis of randomized-controlled trials. Three electronic databases including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched. The primary outcome was the comparison of the performance of CADe systems in ADRs; the secondary outcome was the sessile serrated lesions detection rates (SSLDRs). RESULTS: A total of 48 randomized controlled trials involving 38,986 patients were included in the quantitative analysis. Several CADe systems improved ADR compared with controls that ENDO-AID (risk ratio [RR] 1.26, 95% credible interval [CrI] 1.14-1.40), CADEYE (RR 1.18, 95% CrI 1.10-1.26), and GI Genius (RR 1.15, 95% CrI 1.08-1.22) were supported by moderate confidence evidence according to the Confidence in Network Meta-Analysis (CINeMA). For SSLDR, ENDO-AID (RR 1.36, 95% CrI 1.03-1.79) and GI Genius (RR 1.25, 95% CrI 1.08-1.46) may offer improved detection compared with controls. Across multiple sensitivity analyses excluding studies by withdrawal time, conflicts of interest, limited study numbers, image-enhanced endoscopy, non-parallel design, single-center settings, operator experience, or earlier publication years, the direction and magnitude of ADR improvements with CADe systems remained largely consistent with the primary analysis. CONCLUSIONS: Based on the CINeMA framework, the certainty of evidence ranged from low to moderate, indicating that some CADe systems are likely to improve ADR.
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