New insights on missed colonic lesions during colonoscopy through artificial intelligence-assisted real-time detection (with video)

Background and Aims: Meta-analysis shows that up to 26% of adenomas could be missed during colonoscopy. We investigated whether the use of artificial intelligence (AI)-assisted real-time detection could provide new insights into mechanisms underlying missed lesions during colonoscopy. Methods: A validated real-time deep-learning AI model for the detection of colonic polyps was first tested in videos of tandem colonoscopy of the proximal colon for missed lesions. The real-time AI model was then prospectively validated in a total colonoscopy in which the endoscopist was blinded to real-time AI findings. Segmental unblinding of the AI findings were provided, and the colonic segment was then re-examined when missed lesions were detected by AI but not the endoscopist. All polyps were removed for histologic examination as the criterion standard. Results: Sixty-five videos of tandem examination of the proximal colon were reviewed by AI. AI detected 79.1%(19/24) of missed proximal adenomas in the video of the first-pass examination. In 52 prospective colonoscopies, real-time AI detection detected at least 1 missed adenoma in 14 patients (26.9%) and increased the total number of adenomas detected by 23.6%. Multivariable analysis showed that a missed adenoma(s) was more likely when there were multiple polyps (adjusted odds ratio, 1.05; 95% confidence interval, 1.02-1.09; P<.0001) or colonoscopy was performed by less-experienced endoscopists (adjusted odds ratio, 1.30; 95% confidence interval, 1.05-1.62; P=.02). Conclusions: Our findings provide new insights on the prominent role of human factors, including inexperience and distraction, on missed colonic lesions. With the use of real-time AI assistance, up to 80% of missed adenomas could be prevented.

Automated summary

The study showed that real-time AI detection can significantly decrease the number of missed adenomas during colonoscopy and highlighted the prominent role of human factors such as inexperience and distraction in missed colonic lesions. Up to 80% of missed adenomas could be prevented with the use of real-time AI assistance.