KT+

BACKGROUND & AIMS: Endoscopists' colonoscopy adenoma detection rates (ADRs) are inversely associated with their patients' risk of postcolonoscopy colorectal cancer death. Although randomized controlled trials have found that computer-aided detection (CADe) devices significantly improve ADRs, real-world studies have generally failed to demonstrate a 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 were available from 269 endoscopists at 42 facilities with CADe performing 71,594 pre- and 35,399 postdeployment colonoscopies; and from 547 endoscopists at 97 control facilities performing 151,792 pre- and 75,415 postdeployment colonoscopies. Comparing post- with predeployment colonoscopies, the absolute increase in ADR was 4.2 percentage points (95% CI, 3.48 to 4.74 percentage points), from 50.7% to 54.9%, at CADe sites and ADR decreased by 0.7 percentage points (95% CI, -1.16 to -0.28 percentage points), 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 to 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 compared with usual care. The impact on cancer outcomes and potential endoscopist deskilling remains undetermined.

CLINICALTRIALS: gov Number: NCT05888623.

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