Kong D, Jiao Y, Liu YH. From availability to adoption: Why endoscopist-level use determines the real-world impact of computer-aided detection in colonoscopy. World J Gastroenterol 2026; 32(38): 118617 [DOI: 10.3748/wjg.118617]
Corresponding Author of This Article
Ya-Hui Liu, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. yahui@jlu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
editorial
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Kong D, Jiao Y, Liu YH. From availability to adoption: Why endoscopist-level use determines the real-world impact of computer-aided detection in colonoscopy. World J Gastroenterol 2026; 32(38): 118617 [DOI: 10.3748/wjg.118617]
World J Gastroenterol. Oct 14, 2026; 32(38): 118617 Published online Oct 14, 2026. doi: 10.3748/wjg.118617
From availability to adoption: Why endoscopist-level use determines the real-world impact of computer-aided detection in colonoscopy
Di Kong, Yan Jiao, Ya-Hui Liu
Di Kong, Anesthesia Recovery Room, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Yan Jiao, Ya-Hui Liu, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Co-corresponding authors: Yan Jiao and Ya-Hui Liu.
Author contributions: Jiao Y conceived the study and designed the editorial framework; Liu YH conducted the literature review and evidence synthesis; Kong D drafted the manuscript; Jiao Y and Liu YH are co-corresponding authors and jointly supervised the work; all authors approved the final manuscript. Jiao Y conceived the central concept and overall editorial framework of the manuscript, while Liu YH contributed substantially to the literature synthesis, interpretation of current evidence, and the clinical implementation perspective. Both authors jointly supervised the development of the manuscript and made complementary intellectual contributions throughout the writing and revision process; therefore, designating them as co-corresponding authors appropriately reflects their shared leadership and responsibility for the work.
Conflict-of-interest statement: There is no conflict of interest.
Corresponding author: Ya-Hui Liu, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. yahui@jlu.edu.cn
Received: January 7, 2026 Revised: February 26, 2026 Accepted: March 10, 2026 Published online: October 14, 2026 Processing time: 240 Days and 23.8 Hours
Abstract
Colonoscopy quality, commonly measured by adenoma detection rate (ADR), remains a cornerstone of colorectal cancer prevention. While computer-aided detection (CADe) systems have demonstrated efficacy in controlled trials, their real-world impact has been inconsistent, raising questions about how these technologies should be implemented in daily practice. The recent real-world observational study by Rao et al at an Australian tertiary center provides important insight by shifting attention from technology availability to endoscopist-level adoption. By stratifying endoscopists according to CADe usage frequency, the study demonstrates that even partial use of CADe is associated with meaningful improvements in ADR, while high-frequency use confers additional gains in adenoma yield per procedure. These findings suggest that CADe effectiveness is not an intrinsic property of the technology alone but is largely influenced by user behavior and integration into routine endoscopic workflows. From a gastroenterology perspective, this has important implications: Inconsistent or selective use of CADe may blunt its potential benefits, whereas deliberate adoption strategies could enhance polyp detection and risk stratification. Future efforts should therefore move beyond simple deployment toward optimizing training, adherence, and quality frameworks that encourage appropriate and sustained CADe use in clinical practice. Importantly, this editorial advances prior technology-centered discussions by explicitly framing endoscopist-level adoption intensity as a central explanatory factor for heterogeneous real-world CADe outcomes. From a practice and policy perspective, this adoption-oriented framework highlights the need for structured monitoring, training, and integration of CADe into quality assurance systems rather than passive technological deployment.
Core Tip: Computer-aided detection (CADe) systems have proven efficacy in improving adenoma detection rate during colonoscopy, yet their real-world impact remains heterogeneous. Emerging evidence suggests that CADe effectiveness is not determined by mere availability but by endoscopist-level adoption and integration into routine practice. Stratifying endoscopists by CADe usage frequency reveals a dose-response relationship between use intensity and adenoma yield. These findings underscore the need to shift implementation strategies from passive deployment toward active training, adherence, and behavioral optimization to fully realize the clinical value of CADe, highlighting endoscopist-level adoption as a key translational determinant beyond mere technological availability.
