Gastric neoplasm detection of computer-aided device assisted esophagogastroduodenoscopy changes with different pragmatic implement scenarios: a real-world study

Background: The implementation of computer-aided detection (CAD) devices in esophagogastroduodenoscopy (EGD) could autonomously identify gastric precancerous lesions and neoplasms, and reduce the miss rate of gastric neoplasms in prospective tandem trials. However, there is still insufficient evidence of their use in real-life clinical practice. Method: A real-world, two-center, large-volume, pragmatic study was conducted at Wenzhou Central Hospital (WCH) and Renmin Hospital of Wuhan University (RHWU). Random biopsy and target biopsy were adopted and CAD devices were applied in 2019 and 2021 at WCH and RHWU, respectively. We compared differences in gastric precancerous and neoplasm detection of EGD before and after the use of CAD devices in the first half of the year. Findings: A total of 33885 patients were included and 32886 patients were ultimately analysed. In WCH of which biopsy rate > 95%, with the implementation of CAD, more early gastric cancer detection rate (0.35% vs. 0.59%, p=0.028) was found while gastric neoplasm detection rate (1.39% vs. 1.36%, p=0.897) remained stable. In RHWU of which biopsy rate < 20%, the gastric neoplasm detection rate (1.78% vs. 3.23%, p=0.000) nearly doubled after the implementation of CAD while there was no significant change in the early gastric cancer detection rate. Interpretation: The application of CAD devices devoted to distinct increases in gastric neoplasm detection according to different biopsy strategies, which implied that CAD devices demonstrated optimism while varied effectiveness according to different implementation scenarios. And further CAD devices should be optimized according to their application situations to maximize their effectiveness.