Impact of Endocuff addition to real-time computer-aided detection of colorectal neoplasia in a randomised tandem colonoscopy trial

BACKGROUND Risk of post colonoscopy colorectal cancer is related to adenoma miss rate (AMR) during colonoscopy. Artificial intelligence (AI) and Endocuff Vision are tools both used to increase adenoma detection rate (ADR). AIM To assess whether the combination of AI and Endocuff vision, compared to using AI alone, increases the ADR. METHODS This is a single-center randomized, tandem colonoscopy trial. Patients with a Boston Bowel Preparation score ≥ 6 with an indication of colorectal cancer screening (78, 91.8%) or polyp surveillance (7, 8.2%) were included from the study. RESULTS Eighty-five patients were included in total (male: 51; mean age: 63 ± 8 years old). In 39 patients, the initial colonoscopy was performed using AI alone, while in 45 patients, it was carried out with a combination of AI and Endocuff. Colonoscopies without Endocuff were associated with a numerically higher ADR (19/39, 48.7% vs 14/45, 31.1%, P = 0.107) and an increased number of polyps detected per procedure (1.7 ± 2.5 vs 1.2 ± 1.4, P = 0.272). During tandem colonoscopy, an additional 0.4 ± 0.8 polyps per examination (polyp miss rate = 0.08 ± 0.15), along with 0.3 ± 0.7 adenomas (AMR = 0.10 ± 0.25), were identified. Adding Endocuff to AI during tandem colonoscopy did not provide any benefit in AMR or polyp miss rate when compared to initial AI combined with Endocuff-assisted endoscopy followed by tandem AI-only procedures (0.11 ± 0.24 vs 0.92 ± 0.27, P = 0.727; and 0.10 ± 0.15 vs 0.07 ± 0.14, P = 0.415, respectively). CONCLUSION Adding Endocuff to AI-assisted colonoscopy, according to our results, does not lead to increased adenoma detection.