Comparative Efficacy Of Different Computer-Aided Detection Products in Colonoscopy: A Network Meta-Analysis Of Randomized Controlled Trials
In brief
Three FDA-cleared AI colonoscopy systems boost adenoma detection by up to 25%
A network meta-analysis of 41 randomized trials (31,789 patients) found that only half of the FDA-cleared computer-aided detection tools significantly increased adenoma detection rates, with the best performers raising detection by roughly one-quarter. Effects differed between products and were less consistent at higher baseline detection rates, and the evidence remains low certainty without direct head-to-head trials.
- Journal
- Endoscopy (Q1)
- Published
- 11 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Marcello Maida, Giulio Calabrese, Louis H S Lau, Zhouyao Qian, Alessandro Vitello, Giovanni Marasco, et al.
- PMID
- 42580756
- DOI
- 10.1055/a-2936-2838
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 16 August 2026): Network meta‑analysis of CADe systems, colonoscopy
Abstract
BACKGROUND AND AIMS: Multiple computer-aided detection (CADe) systems have been developed to improve adenoma detection during colonoscopy, but their comparative efficacy and consistency of effect remain uncertain. This network meta-analysis aimed to compare the efficacy of different CADe systems across multiple detection outcomes. METHODS: MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing CADe-assisted colonoscopy versus colonoscopy without CADe or other CADe systems. The primary outcome was adenoma detection rate (ADR). Secondary outcomes were adenomas per colonoscopy (APC) and adenoma miss rate (AMR). A random-effects network meta-analysis was performed to synthesize direct and indirect evidence. RESULTS: Forty-one RCTs (31,789 patients; 14 CADe systems) were included. In the exploratory complete-network analysis, 10 of 14 systems significantly improved ADR (RR range 1.12-1.76), 9 increased APC, and 3 reduced AMR. In the FDA-cleared systems analysis, 3 of 6 improved ADR (RR range 1.14-1.25), whereas 3 did not. Several systems retained a significant benefit in studies meeting the control-arm ADR thresholds recommended by ESGE (≥25%) and ASGE/ACG (≥35%), although effects varied across platforms and attenuation at higher baseline ADR was not uniform. Baseline ADR was not associated with treatment effects in meta-regression. CONCLUSIONS: The effectiveness of CADe-assisted colonoscopy is not uniform across platforms and varies according to the specific product. These findings support a system-specific rather than class-based evaluation of CADe technologies. However, comparative estimates should be interpreted cautiously given the low certainty of evidence for several outcomes and the absence of head-to-head comparisons and closed loops within the network.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.