Comparing Advanced Adenoma Detection Rate Between Water Exchange and Computer-Aided Colonoscopy Using Pooled Data From Randomized Controlled Trials

Introduction: Advanced adenoma is defined as any adenoma ≥1 cm, with significant villous pathology, or with high-grade dysplasia. Advanced adenoma bridges benign and malignant states and may be an important surrogate for future and present colorectal cancer risks. Advanced adenoma detection has been advocated as an important target for screening colonoscopy. Both water exchange (WE) and computer-aided detection colonoscopy (CADe) have been shown to significantly improve adenoma detection rate (ADR). We aimed to compare the advanced adenoma detection rate (AADR) between WE and CADe using conventional colonoscopy as the common comparator. Methods: The literature database was searched for randomized controlled trials (RCTs) that included WE or CADe using the keywords, water exchange colonoscopy, artificial intelligence, computer-aided detection colonoscopy, and adenoma detection. The literature was reviewed and articles that reported AADR were included in our study. Data were extracted and pooled manually. Using the chi-square test, we compared AADR of WE and CADe with respective conventional colonoscopy controls and each other. Results: The initial keyword search identified 278 articles; 16 RCTs met inclusion criteria and were included in our study. In 8 RCTs, a total of 6432 patients underwent WE or conventional colonoscopy. WE significantly improved AADR compared with conventional colonoscopy (9.7% vs 7.3%, P=0.00062). Another 8 RCTs examined CADe and reported AADR. They included a total of 7032 patients who underwent either CADe or conventional colonoscopy. AADR for CADe (9.1%) was significantly higher than conventional colonoscopy (7.5%, P=0.0166). There was no significant difference in AADR between WE and CADe (9.7% vs 9.1%, P=0.39). Conclusion: Both WE and CADe significantly improved detection of advanced adenoma compared with conventional colonoscopy. There was no significant difference in AADR between WE and CADe in the chi-square analysis. To account for population differences, future report will analyze the data utilizing meta-analysis with random effect model. Table 1. - Randomized Controlled Trials Comparing Advanced Adenoma Detection Rate of Water Exchange or Computer Aided Detection Colonoscopy With Conventional Colonoscopy Author, year Country Number of centers Type Sample size Male percentage Mean age Mean withdrawal time (min) Mean Boston bowel preparation score AADR Hsieh, 2017 Taiwan 2 WE 217 55.8 55.7 13.1 7.1 14.6 Hsieh, 2017 Taiwan 2 Conventional 217 48.4 54.8 12.0 6.2 11.5 Leung, 2010 USA 1 WE 42 66.0 22.0 16.7 Leung, 2010 USA 1 Conventional 40 66.8 19.0 7.5 Cadoni, 2014 Italy 2 WE 338 60.0 58.0 10.0 9.5 Cadoni, 2014 Italy 2 Conventional 334 61.1 60.0 9.0 5.7 Jia, 2017 China 6 WE 1653 50.2 50.3 7.3 7.3 6.2 Jia, 2017 China 6 Conventional 1650 51.8 50.3 7.4 7.0 7.5 Garborg, 2015 Norway and Poland 2 WE 234 51.3 60.0 15.0 7.3 7.0 Garborg, 2015 Norway and Poland 2 Conventional 239 50.6 61.0 13.0 7.3 8.0 Tseng, 2022 Taiwan 1 WE 144 52.1 58.9 11.8 8.2 18.8 Tseng, 2022 Taiwan 1 Conventional 140 48.6 59.7 12.4 7.3 12.9 Ramirez, 2011 USA 1 WE 177 96.6 60.0 12.9 8.5 Ramirez, 2011 USA 1 Conventional 191 96.3 59.3 13.7 9.9 Cadoni, 2017 Italy and Czech Republic 3 WE 408 54.9 61.4 8.7 8.3 19.4 Cadoni, 2017 Italy and Czech Republic 3 Conventional 408 55.1 60.9 8.3 7.7 14.2 Repici, 2020 Italy 3 CADe 341 50.4 61.5 7.0 7.4 10.3 Repici, 2020 Italy 3 Conventional 344 49.6 61.1 7.3 7.4 7.3 Repici, 2022 Italy and Switzerland 5 CADe 330 52.7 61.9 8.2 7.4 12.7 Repici, 2022 Italy and Switzerland 5 Conventional 330 47.3 62.2 8.9 7.48 12.7 Xu, 2023 China and Hong Kong 6 CADe 1519 46.5 57.5 9.0 7.0 6.6 Xu, 2023 China and Hong Kong 6 Conventional 1540 47.3 57.0 8.4 7.0 4.9 Yao, 2022 China 1 CADe 268 45.2 50.7 9.9 84.7 4.1 Yao, 2022 China 1 Conventional 271 42.1 50.9 9.4 85.2 1.9 Aniwan, 2023 Thailand 1 CADe 312 42.6 62.8 9.5 8.1 8.3 Aniwan, 2023 Thailand 1 Conventional 310 42.9 62.0 9.2 8.2 7.7 Gimeno-Garcia, 2023 Spain 1 CADe 155 52.9 63.0 8.9 7.4 11.6 Gimeno-Garcia, 2023 Spain 1 Conventional 157 52.9 64.7 7.8 7.2 12.1 Kamba, 2021 Japan 4 CADe 178 76.4 61.6 7.2 6.4 Kamba, 2021 Japan 4 Conventional 177 76.8 61.4 7.5 6.3 Rondonotti, 2022 Italy 5 CADe 405 52.6 62.0 9.3 18.5 Rondonotti, 2022 Italy 5 Conventional 395 49.6 61.0 8.9 15.9 (CADe, computer-aided detection; AADR, advanced adenoma detection rate; WE, water exchange).