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On March 20, 2025, we reported on a new American Gastroenterological Association (AGA) living clinical practice guideline published in Gastroenterology on the use of computer-aided detection (CADe) systems during colonoscopy.
The review
A multidisciplinary panel of content experts and guideline methodologists conducted a systematic review of 44 randomized controlled trials (RCTs) involving more than 30 000 participants, in addition to a microsimulation modeling study and patient and provider surveys. They used the Grading of Recommendations Assessment, Development and Evaluation framework.
The findings
The guideline panel noted that CADe-assisted colonoscopy was associated with an 8% absolute increase in adenoma detection rate (ADR) (44.8% vs 37.4%; relative risk [RR], 1.22; 95% CI, 1.16–1.29) and a reduction in adenoma miss rate by 19% (RR, 0.47; 95% CI, 0.36–0.60). However, these improvements were largely driven by the detection of diminutive polyps of low malignant potential. The panel also reported a modest increase in detection rates of advanced colorectal neoplasia (2% absolute increase; RR, 1.16; 95% CI, 1.02–1.32). Despite these favorable findings on surrogate markers, the evidence regarding the impact on critical long-term outcomes—such as colorectal cancer (CRC) incidence and CRC-related mortality—remains very low in certainty.
Given the close tradeoff between the modest improvements in ADR and the potential for overdiagnosis and increased resource use, the guideline panel concluded with no recommendation for or against the routine use of CADe-assisted colonoscopy.
Authors' comments
"This guideline highlights the close tradeoff between desirable and undesirable effects and the limitations in the current evidence to support a recommendation. The panel acknowledged the potential for CADe to continually improve as an iterative artificial intelligence application. Ongoing publications providing evidence for critical outcomes will help inform a future recommendation."
