S655 AI-Enhanced Colonoscopy Improves Adenoma Detection Without Delaying Procedure: Meta-Analysis of 9,500 Patients

Introduction: Colorectal cancer (CRC) is a major global health challenge, with nearly 2 million new cases reported in 2020. Colonoscopy is the cornerstone of CRC prevention, and adenoma detection rate (ADR) is a validated performance metric inversely associated with interval CRC. Yet, ADR varies significantly among endoscopists. Computer-aided detection (CADe) systems using artificial intelligence (AI) offer real-time support that may improve detection consistency. While single studies and trials suggest benefit, a robust synthesis across diverse settings is lacking. Methods: Following PRISMA guidelines, we searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov (2000–2024) using terms such as “AI-assisted colonoscopy” and “adenoma detection.” Eligible studies included randomized controlled trials and cohort studies comparing AI-assisted to standard colonoscopy and reporting ADR, polyp detection rate (PDR), and missed adenoma rate (MAR). Two independent reviewers assessed study quality using Cochrane Risk of Bias and Newcastle-Ottawa tools. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Publication bias was evaluated using Egger’s test and funnel plots. Results: Thirty-eight studies (22 RCTs, 16 cohort studies) including 9,500 patients were analyzed. AI-assisted colonoscopy significantly increased ADR (31.5% vs 25.3%; odds ratio [OR] 1.48, 95% CI 1.35–1.62; P < 0.01) and PDR (48.2% vs 39.4%; OR 1.42, 95% CI 1.30–1.53; P < 0.01). MAR from tandem studies was significantly lower in the AI group (16.9% vs 24.5%; P = 0.01). Detection of diminutive adenomas (<5 mm; P = 0.02) and sessile serrated lesions (P = 0.03) also improved. No significant difference in withdrawal time was found (P = 0.07). Findings align with key multicenter trials including COLO-DETECT (OR 1.47, 95% CI 1.21–1.78; P < 0.0001). No significant publication bias was observed. Conclusion: AI-enhanced colonoscopy significantly improves ADR and reduces missed lesions, including subtle and flat polyps, without extending procedure time. These findings support routine AI integration into colorectal cancer screening to enhance diagnostic consistency and potentially reduce interval cancers.