Effectiveness of CADe in Colonoscopy for Improved Adenoma and Polyp Detection Under Diverse Clinical Conditions

<h3>Background/Aim:</h3> Colonoscopy is the gold standard for colorectal cancer prevention, but its effectiveness is limited by missed lesions and operator-dependent variability. Computer-aided detection (CADe) has been introduced to mitigate these limitations, yet its value for endoscopists with different levels of expertise remains unclear. This study evaluated the real-world effectiveness of CADe, focusing on its differential impact on experts and trainees under diverse clinical conditions. <h3>Patients and Methods:</h3> We conducted a retrospective, comparative study of consecutive colonoscopies performed at a tertiary center. To reduce potential selection bias, we applied 1:1 propensity score matching (PSM), yielding 724 matched patients (362 CADe <i>vs.</i> 362 non-CADe). Primary outcomes were adenoma detection rate (ADR) and polyp detection rate (PDR), stratified by operator expertise, bowel preparation quality, and lesion characteristics. <h3>Results:</h3> The CADe group demonstrated significantly higher overall ADR (40.6% <i>vs.</i> 30.4%, <i>p</i>=0.004) and PDR (60.2% <i>vs.</i> 50.6%, <i>p</i>=0.011). In subgroup analyses, experts achieved a significant increase in ADR (44.7% <i>vs.</i> 34.0%, <i>p</i>=0.022) even within a lower-risk patient cohort, supporting a refinement effect. Trainees showed a numerical increase in ADR (32.2% <i>vs.</i> 25.9%, <i>p</i>=0.251) in a higher-risk cohort, with performance approaching the baseline detection rates of experts. CADe was particularly effective for detecting small polyps (≤5 mm; <i>p</i>=0.002) and in patients with optimal bowel preparation (BBPS ≥7; <i>p</i>=0.008). Significant improvements were observed in the transverse colon and descending colon. <h3>Conclusion:</h3> CADe significantly enhances adenoma and polyp detection in real-world practice. Its utility varies by operator experience, serving as a refinement tool for experts to detect subtle lesions and a safety net for trainees to bridge the experience gap. Adequate bowel preparation is essential for maximizing these benefits.