Gaze Shift to Screen Edge Boosts Colorectal Adenoma Detection: Multicenter Randomized Controlled Trial (EYE-SIGHT Trial)

BACKGROUND & AIMS: Colorectal cancer prevention depends on accurate detection and complete resection of adenomas. Optimal visual strategy remains undefined. We investigated whether guiding the gaze toward the periphery of the screen could enhance adenoma detection. METHODS: This multicenter, randomized controlled trial was conducted across 4 institutions between September 2024 and July 2025. Individuals aged 40 to 90 years were randomized to the intervention or control group. In the intervention group, real-time eye-tracking feedback prompted endoscopists to maintain gaze on peripheral areas-defined as 16 outer segments of a 5 × 5 screen grid-through alerts, whereas no feedback was provided in the control group. The primary endpoint was adenomas per colonoscopy. Secondary endpoints included adenoma detection rate, polyp detection rate, peripheral gaze rate, and observation time. RESULTS: Four hundred patients were enrolled, with 198 in the intervention group and 199 in the control group. The mean age was comparable between groups (68.9 vs 68.6 years), and other baseline characteristics were balanced. The intervention group achieved significantly higher adenomas per colonoscopy than the control group (1.34 vs 0.95; P = .046). Adenoma detection rate (53.3% vs 39.2%; P = .007) and polyp detection rate (66.5% vs 47.2%; P < .001) were significantly improved. The peripheral gaze rate was greater in the intervention group (33.7% vs 25.9%; P < .001), whereas observation time did not differ significantly (8.4 vs 8.0 minutes; P = .094). CONCLUSIONS: Increased peripheral gaze by real-time guidance significantly improved adenoma and polyp detection without extending procedure time. This low-burden, scalable approach may offer a simple, effective method to improve colonoscopy.