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Published on: August 1, 2019
Impact of Availability of Computer-Aided Detection Devices on Adenoma Detection During Colonoscopy: A Cluster
Jason A Dominitz1, Andrew J Gawron2, Grace B McKee3
1National Gastroenterology and Hepatology Program, Veterans Health Administration, Washington, District of Columbia; Division of Gastroenterology, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington.
Computer-aided detection (CADe) devices significantly improved adenoma detection rates during colonoscopies in a real-world study. This technology enhanced adenoma detection compared to usual care, though long-term cancer outcome effects are still unknown.
Area of Science:
- Gastroenterology
- Medical Technology
- Colorectal Cancer Prevention
Background:
- Endoscopist adenoma detection rates (ADR) are linked to post-colonoscopy colorectal cancer mortality.
- While randomized trials show computer-aided detection (CADe) improves ADR, real-world evidence has been lacking.
Purpose of the Study:
- To evaluate the real-world effectiveness of CADe devices in improving adenoma detection rates (ADR) during colonoscopies.
- To assess the impact of CADe availability on colonoscopy outcomes in a pragmatic quality improvement study.
Main Methods:
- A pragmatic quality improvement study was conducted in Veterans Health Administration facilities.
- Facilities were randomly assigned to either receive CADe devices or serve as controls, with deployment dates randomized.
- Mixed effects logistic regression analyzed the effect of CADe availability on adenoma detection.
Main Results:
- At CADe sites, adenoma detection rates (ADR) increased by 4.2 percentage points post-deployment, while control sites saw a 0.7 percentage point decrease.
- CADe availability was significantly associated with increased odds of adenoma detection (OR 1.22).
- No association was found between CADe availability and detection of other lesions or changes in withdrawal time.
Conclusions:
- The availability of CADe devices led to a significant increase in adenoma detection compared to usual care.
- The long-term impact of CADe on colorectal cancer outcomes and potential endoscopist deskilling requires further investigation.
