Controversies in Computer-Assisted Detection in Colonoscopy

(1) CADe improves ADR in RCTs, but real-world effectiveness is inconsistent and often lacklustre. (2) Gains in ADR are largely derived from diminutive adenomas, and less with advanced adenomas, with uncertain impact on clinically significant outcomes such as colorectal cancer incidence and mortality. (3) Cost-effectiveness analyses are generally favourable, but dependent on assumptions about ADR improvement, CADe cost, and surveillance policies. (4) Deskilling and altered endoscopist behaviour represent important considerations that require further study. (5) Future integration of CADe with computer-aided diagnosis (CADx) and quality-assurance (CAQ) tools may maximize clinical benefit and cost-effectiveness, but evidence gaps must be addressed before widespread implementation.