Efficacy of artificial intelligence in detecting precancerous lesions among a colorectal cancer screening population undergoing surveillance colonoscopies in Italy: a randomized control trial (GENIAL-CO Follow-Up study)
In brief
AI-assisted colonoscopy does not boost adenoma detection in surveillance patients
In a randomized trial of 914 Italian patients undergoing surveillance colonoscopy, adenoma detection rates were similar with and without computer-aided detection (66.6% vs 61.0%). Although the AI group removed more adenomas per exam, procedures took about two minutes longer, and the benefit did not extend to advanced lesions or serrated polyps. The findings suggest AI may not add value in post-polypectomy surveillance.
- Journal
- Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Q1)
- Published
- 6 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Cristiano Spada, Paola Cesaro, Lorenzo Fuccio, Daniele Salvi, Clarissa Ferrari, Federico Barbaro, et al.
- PMID
- 42838765
- DOI
- 10.1016/j.dld.2026.08.031
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 8 October 2026): CADe did not improve ADR in surveillance colonoscopy
Abstract
BACKGROUND AND AIMS: Computer-aided detection (CADe) has demonstrated improved adenoma detection rate (ADR) in screening populations; however, its value in post-polypectomy surveillance colonoscopy remains unclear. This study evaluated CADe efficacy in enhancing detection metrics during surveillance colonoscopy within an organized colorectal cancer (CRC) screening program. METHODS: In this multicenter randomized controlled trial, patients aged 50-74 scheduled for surveillance colonoscopy were randomized 1:1 to CADe-assisted or standard colonoscopy (SC). The primary endpoint was ADR. Secondary endpoints included advanced ADR, adenomas per colonoscopy (APC), sessile serrated lesion detection rate (SSLDR), and withdrawal time (WT). RESULTS: Of 973 enrolled patients, 914 were included after excluding 59 with inadequate bowel preparation (CADe: 455 vs SC: 459). ADR and AADR did not differ significantly between groups (66.6%vs 61.0%, p = 0.160; 7.3% vs 6.3%, p = 0.263). APC was significantly higher in the CADe group (1.80±2.19 vs 1.32±1.75, p < 0.001), while SSLDR was comparable (17.1%vs 14.2%, p = 0.154). Mean WT was significantly longer with CADe (16.35±8.32 vs 14.52±7.24 min, p < 0.001). CONCLUSIONS: CADe-assisted colonoscopy did not improve ADR or AADR in a CRC organized screening population undergoing surveillance colonoscopy, while significantly increasing WT.
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.