Availability and use of computer-aided detection during colonoscopy: A real-world observational study at an Australian tertiary center

Table 1 Patient baseline characteristics, n (%)

Characteristic	Pre-CADe	Post-CADe	P value
Age (years)	59.4 (40-89)	63.2 (41-87)	< 0.001a
Male	299 (47.8)	173 (47.9)	0.986
Indication: Iron deficiency ± anaemia	117 (17.5)	94 (19.0)	< 0.05b
Indication: Faecal occult blood positive	72 (10.8)	70 (14.1)	0.087
Indication: Polyp surveillance	76 (11.4)	63 (12.7)	0.497
Average total BBPS score	7.3 (3-9)	7.4 (3-9)	0.744
Median total procedure time (minute)	18 (1-169)	23 (1-408)	< 0.05

^aP < 0.001.

^bP < 0.05.

CADe: Computer-aided detection; BBPS: Boston Bowel Preparation Scale.

Table 2 Impact of computer-aided detection use frequency on polyp detection rate, adenoma detection rate, and sessile serrated lesion detection rate

CADe use (n)	PDR % (No. of procedures)				ADR % (No. of procedures)				SSL-DR % (No. of procedures)
	Pre	Post	OR (CI)	P value	Pre	Post	OR (CI)	P value	Pre	Post	OR (CI)	P value
100% (2)	82.3 (226)	78.7 (267)	0.79 (0.51-1.24)	0.31	64.2 (226)	58.1 (267)	0.77 (0.54-1.11)	0.17	19.5 (226)	18.7 (267)	0.83 (0.61-1.50)	0.83
50%-99% (4)	46.3 (393)	63.8 (105)	2.04 (1.31-3.19)	< 0.01b	29.0 (393)	41.9 (105)	1.77 (1.13-2.75)	0.01b	9.7 (393)	11.4 (105)	1.20 (0.61-2.40)	0.59
0% (1)	52.9 (17)	50.0 (14)	0.88 (0.22-3.66)	0.87	23.6 (17)	14.3 (14)	0.54 (0.083-3.51)	0.52	11.8 (17)	21.4 (14)	2.04 (0.29-14.3)	0.47

^bP < 0.05.

CADe: Computer aided detection; PDR: Polyp detection rate; ADR: Adenoma detection rate; SSL-DR: Sessile serrated lesion detection rate; CI: Confidence interval; OR: Odds ratio.

Table 3 Sensitivity analysis with diagnostic colonoscopies excluded

CADe use (n)	PDR % (No. of procedures)			ADR % (No. of procedures)			SSL-DR % (No. of procedures)
	Pre	Post	P value	Pre	Post	P value	Pre	Post	P value
100% of time (2)	93.1 (102)	89.2 (102)	0.46	78.4 (102)	70.6 (102)	0.26	19.6 (102)	22.5 (102)	0.73
50%-99% of time (4)	68.2 (134)	72.7 (44)	0.71	47.0 (134)	50 (44)	0.86	16.4 (134)	15.9 (44)	1.00
0% of time (1)	66.7 (3)	66.7 (3)	1.00	66.7 (3)	0 (3)	0.40	33.3 (3)	33.3 (3)	1.00

CADe: Computer aided detection; PDR: Polyp detection rate; ADR: Adenoma detection rate; SSL-DR: Sessile serrated lesion detection rate; OR: Odds ratio.

Table 4 Multivariable logistic regression with mixed effects - assessing factors associated with adenoma detection rate

Variable	OR	95%CI	P value
CADe era	1.47	1.07-2.01	0.02b
Patient age (years)	1.00	0.99-1.01	0.41
Procedure time of day (PM vs AM)	0.92	0.67-1.26	0.61
Procedure time (minutes)	1.01	1.00-1.02	0.02b
Indication: Surveillance compared to screening	2.19	1.45-3.30	< 0.001a
Indication: Diagnostic compared to screening	1.53	1.08-2.19	0.02b
BBPS score (total)	0.97	0.88-1.06	0.50

^aP < 0.001.

^bP < 0.05.

Random intercept included for endoscopist to account for clustering by endoscopist. Reference group for indication is screening. CADe: Computer-aided detection; OR: Odds ratio; CI: Confidence interval; BBPS: Boston Bowel Preparation Scale.

Table 5 Mixed-effects multivariable regression stratified by procedure indication

Variable	OR	95%CI	P value
Screening
CADe era	1.30	0.59-2.87	0.52
Patient age (years)	1.02	0.99-1.04	0.23
Procedure time of day (PM vs AM)	0.40	0.18-0.85	0.02
BBPS score (total)	0.87	0.67-1.12	0.29
Procedure time	1.01	0.99-1.04	0.22
Surveillance
CADe era	1.27	0.70-2.29	0.43
Patient age (years)	0.99	0.98-1.01	0.73
Procedure time of day (PM vs AM)	1.11	0.61-2.01	0.72
BBPS score (total)	1.10	0.93-1.32	0.32
Procedure time	1.00	0.99-1.02	0.74
Diagnostic
CADe era	1.76	1.17-2.63	0.006b
Patient age (years)	1.01	0.99-1.02	0.35
Procedure time of day (PM vs AM)	1.10	0.72-1.67	0.67
BBPS score (total)	0.94	0.82-1.07	0.34
Procedure time	1.01	0.99-1.02	0.08

^aP < 0.001.

^bP < 0.05.

Reference group for indication is screening. CADe: Computer-aided detection; CI: Confidence interval; BBPS: Boston Bowel Preparation Scale.