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World J Gastroenterol. Aug 7, 2026; 32(29): 116893
Published online Aug 7, 2026. doi: 10.3748/wjg.116893
Impact of computer-aided polyp detection in screening and diagnostic colonoscopy: A multicenter randomized controlled trial
Gian Eugenio Tontini, Lorenzo Dioscoridi, Raffaele Salerno, Giovanni Aldinio, Matteo Rossano Buonocore, Paola Cesaro, Francesco Conforti, Dario Consonni, Irene Cottone, Emanuele Dabizzi, Beatrice Mantia, Fabio Monica, Massimiliano Mutignani, Nicola Olivari, Giulia Picardi, Daniele Salvi, Lucia Scaramella, Mario Schettino, Matilde Topa, Maurizio Vecchi, Luca Elli
Gian Eugenio Tontini, Giovanni Aldinio, Giulia Picardi, Matilde Topa, Maurizio Vecchi, Luca Elli, Department of Pathophysiology and Organ Transplantation, University of Milan, Milan 20122, Lombardy, Italy
Gian Eugenio Tontini, Francesco Conforti, Emanuele Dabizzi, Lucia Scaramella, Maurizio Vecchi, Luca Elli, Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Lombardy, Italy
Lorenzo Dioscoridi, Irene Cottone, Massimiliano Mutignani, Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan 20162, Lombardy, Italy
Raffaele Salerno, Beatrice Mantia, Mario Schettino, Division of Gastroenterology, ASST Fatebenefratelli Sacco, Milan 20162, Lombardy, Italy
Matteo Rossano Buonocore, Fabio Monica, Department of Gastroenterology and Digestive Endoscopy, Academic Hospital Cattinara, Trieste 34149, Friuli Venezia Giulia, Italy
Paola Cesaro, Nicola Olivari, Daniele Salvi, Gastroenterology and Digestive Endoscopy Unit, Poliambulanza Brescia Hospital, Brescia 25124, Lombardy, Italy
Dario Consonni, Occupational Health Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano 20122, Lombardy, Italy
Author contributions: Tontini GE, Dioscoridi L, Salerno R, Vecchi M, and Elli L contributed to conceptualization; Consonni D contributed to data curation and formal analysis; Tontini GE, Dioscoridi L, Salerno R, Aldinio G, Buonocore MR, Cesaro P, Conforti F, Cottone I, Dabizzi E, Mantia B, Monica F, Mutignani M, Olivari N, Salvi D, Scaramella L, Schettino M, Topa M, Vecchi M, and Elli L contributed to investigation; Tontini GE, Consonni D, Vecchi M, and Elli L contributed to methodology; Tontini GE, Vecchi M, and Elli L contributed to project administration and supervision; Tontini GE, Dioscoridi L, Salerno R, Vecchi M, and Elli L contributed to validation; Tontini GE, Dioscoridi L, Salerno R, Aldinio G, Topa M, Vecchi M, and Elli L contributed to visualization; Tontini GE, Dioscoridi L, Salerno R, Aldinio G, Buonocore MR, Cesaro P, Conforti F, Consonni D, Cottone I, Dabizzi E, Mantia B, Monica F, Mutignani M, Olivari N, Picardi G, Salvi D, Scaramella L, Schettino M, Topa M, Vecchi M, and Elli L contributed to writing of original draft, and review and editing. All authors have read and approve the final manuscript.
Supported by Italian Ministry of Education and Research - MUR; Italian Ministry of Health, No. RC2026/150/01.
Institutional review board statement: The research protocol was reviewed and approved by the Institutional Review Board of Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, No. OSMAMI-15/09/2022-0042892-U.
Clinical trial registration statement: The trial was registered on ClinicalTrials.gov, No. NCT07171333.
Informed consent statement: Written informed consent was obtained from all participants prior to their inclusion in the study, in accordance with the ethical standards of the Declaration of Helsinki.
Conflict-of-interest statement: Dr. Tontini reports PENTAX Medical Europe loaned the DISCOVERY™ systems for the duration of the study.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Data collected with deidentified participants will be available from the corresponding author upon request.
Corresponding author: Gian Eugenio Tontini, MD, PhD, Assistant Professor, Department of Pathophysiology and Organ Transplantation, University of Milan, Via della Commenda 19, Milan 20122, Lombardy, Italy.
gianeugenio.tontini@unimi.it
Received: November 24, 2025
Revised: February 13, 2026
Accepted: April 22, 2026
Published online: August 7, 2026
Processing time: 235 Days and 21.7 Hours
BACKGROUND
Colonoscopy is the reference standard for the diagnosis of polyps and neoplasms of the lower gastrointestinal tract. Recently, real-time artificial intelligence algorithms have been developed to minimize human error in detecting lesions during colonoscopy. Although the performance of these systems on still images and real-time video appears extremely promising, robust evidence of their ability to improve everyday clinical practice is still lacking.
AIM
To evaluate the use of a computer-aided detection (CADe) system on polyp detection rate, adenoma detection rate (ADR), advanced ADR, and sessile serrated lesion detection rate, in addition to ultra-high-definition (UHD) systems in screening and diagnostic procedures, stratified by expertise and fatigue.
METHODS
Between August 2023 and September 2024, patients were randomized (1:1) to UHD colonoscopy with or without CADe (DISCOVERY™) at five Italian tertiary centers. Endoscopists were categorized by annual volume (< 200 or ≥ 200 procedures) and assessed for work-related fatigue (i.e., daily working hours and number of procedures).
RESULTS
Of 421 randomized patients, 409 were included in the per-protocol population. The CADe group were similar in polyp detection rate [CADe: 41.2% vs conventional colonoscopy (CC): 45.4%], ADR (CADe: 29.4% vs CC: 32.2%), advanced ADR (CADe: 5.9% vs CC: 5.4%), or sessile serrated lesion detection rate (CADe: 6.3% vs CC: 8.7%). Results remained consistent across different indications, operator expertise, and fatigue levels.
CONCLUSION
CADe did not improve detection rates over UHD colonoscopy in tertiary centers. No robust evidence of effect modification by operator volume or workload-related fatigue was observed, although the findings in low-volume endoscopists may warrant further investigation in larger studies.
Core Tip: This study shows that in tertiary centers, computer-aided detection (CADe) did not enhance overall polyp or adenoma detection compared with conventional, ultra-high-definition colonoscopy. High-volume endoscopists did not benefit and in some cases performed slightly worse with CADe. Indicators of operator fatigue did not significantly influence CADe effectiveness.
