Impact of Availability of Computer-Aided Detection Devices on Adenoma Detection During Colonoscopy: A Cluster Randomized Study.

BACKGROUND AND AIMS: Endoscopists' colonoscopy adenoma detection rates (ADR) are inversely associated with their patients' risk of post-colonoscopy colorectal cancer death. Though randomized controlled trials have demonstrated that computer-aided detection (CADe) devices significantly improve ADR, real-world studies have generally failed to demonstrate benefit. METHODS: In this pragmatic quality improvement study, randomly selected Veterans Health Administration facilities were equipped with CADe devices between October 2022 and February 2023. Control facilities were assigned a random deployment date. Adenoma detection was determined for colonoscopies and mixed effects logistic regression was used to assess the independent effect of CADe availability on colonoscopy outcomes. RESULTS: Colonoscopy data was available from 269 endoscopists at 42 facilities with CADe, performing 71,594 pre- and 35,399 post-deployment colonoscopies; and from 547 endoscopists at 97 control facilities, performing 151,792 pre- and 75,415 post-deployment colonoscopies. Comparing post- to pre-deployment, the absolute increase in ADR was 4.2 percentage points (95% confidence interval (CI) 3.48-4.74), from 50.7% to 54.9%, at CADe sites and ADR decreased by 0.7 percentage points (95% CI -1.16 to -0.28), from 51.8% to 51.1%, at control sites. Using multivariable regression, CADe availability was associated with a significantly increased odds of adenoma detection (odds ratio 1.22; 95% CI 1.15-1.28) but was not associated with detection of other lesions or changes in withdrawal time. Baseline endoscopist ADR quintiles were not associated with the impact of CADe availability on ADR. CONCLUSIONS: Availability of CADe devices was associated with a significant increase in adenoma detection as compared to usual care. The impact on cancer outcomes and potential endoscopist deskilling remains undetermined; ClinicalTrials.gov #NCT05888623.