Artificial intelligence-based computer-aided detection systems for adenomas during colonoscopy: a systematic review and Bayesian network meta-analysis.

BACKGROUND AND AIMS: Artificial intelligence-based computer-aided detection (CADe) systems have been developed to enhance the adenoma detection rate (ADR) during colonoscopy, but their performance is unknown. We primarily aimed to compare the effectiveness of each CADe system with conventional colonoscopy (CC). As a secondary objective, we performed an exploratory comparison among different CADe systems. METHODS: A systematic literature search of 6 databases was conducted to find randomized controlled trials (RCTs) evaluating the use of CADe systems during colonoscopy. A Bayesian network meta-analysis was performed on the included studies using R 4.5.2 software. The primary outcome was ADR. RESULTS: A total of 21 RCTs involving 19,006 participants were included. Nine CADe systems were compared. For ADR based on modified intention-to-treat (ADR-mITT), DEEP2 (RR 1.37; 95% CrI 1.07-1.76), Eagle-Eye (RR 1.19; 95% CrI 1.02-1.38), and ENDO-AID (RR 1.27; 95% CrI 1.13-1.41) were significantly higher than CC. For ADR based on intention-to-treat (ADR-ITT), AQCS was significantly higher than CC. For adenoma per colonoscopy (APC) and diminutive adenoma detection rate (DADR), ENDO-AID showed significant advantages over CC. However, no significant differences were observed among CADe systems in terms of high-risk lesion detection rate (including advanced adenoma detection rate [AADR] and sessile serrated lesion detection rate [SDR]) or withdrawal time (WT). CONCLUSION: Compared with CC, the CADe system significantly improved ADR. However, given the limited direct comparative evidence and the star-shaped network, the results, especially the differences among systems, should be interpreted cautiously. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261290518, identifier: CRD420261290518.