AI-assisted second forward-view examination of the right colon significantly improves the adenoma detection rate: a multicenter randomized controlled trial
In brief
Second AI-assisted forward view raises right-colon adenoma detection by 8.5%
In a multicenter trial of 606 patients, adding a real-time AI-guided second forward-view exam of the right colon increased the adenoma detection rate from 27.9% to 36.4%, an absolute gain of 8.5%. The benefit was seen for small, flat lesions and across endoscopist experience levels, though the specific role of AI alone still needs clarification.
- Journal
- The American journal of gastroenterology (Q1)
- Published
- 20 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Yusuke Nishikawa, Ai Fujimoto, Yorihito Hayashi, Junji Tanaka, Nobuyuki Sato, Keita Suzuki, et al.
- PMID
- 42633947
- DOI
- 10.14309/ajg.0000000000004184
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 30 August 2026): AI-assisted second view improves right colon adenoma detection
Abstract
BACKGROUND: Adenomas in the right colon are likely to be missed during colonoscopy because of anatomical complexity and lesion characteristics. Although reinspection strategies and artificial intelligence (AI)-assisted colonoscopy improve adenoma detection, prospective randomized studies of their combined effectiveness in the right colon are limited. This multicenter randomized controlled trial aimed to compare standard colonoscopy with an AI-assisted second forward-view examination of the right colon to determine whether this strategy improves the adenoma detection rate (ADR). METHODS: Patients undergoing colonoscopy were randomly assigned in a 1:1 ratio to either the AI-assisted colonoscopy group (AI group) or the standard colonoscopy group (non-AI group). In the AI group, a second forward-view examination of the right colon was performed using real-time AI assistance. The primary outcome was the right colon ADR. RESULTS: A total of 606 patients were included in the analysis (AI group, n = 305; non-AI group, n = 301). The right colon ADR in the AI group was significantly higher than that in the non-AI group (36.4% vs. 27.9%; p = 0.03; absolute increase, 8.5%). The improvement was driven by increased detection of small, flat lesions and those in anatomically challenging regions, such as the ascending colon. Subgroup analyses showed consistent improvement in the right colon ADR with AI assistance regardless of endoscopist experience. CONCLUSIONS: The AI-assisted second forward-view examination significantly improved the right colon ADR. This combined strategy may improve adenoma detection in the right colon regardless of endoscopist experience. However, the independent contribution of AI assistance warrants further investigation.
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.