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Repici A, Spadaccini M, Antonelli G, Correale L, Maselli R, Galtieri PA, Pellegatta G, Capogreco A, Milluzzo SM, Lollo G, Di Paolo D, Badalamenti M, Ferrara E, Fugazza A, Carrara S, Anderloni A, Rondonotti E, Amato A, De Gottardi A, Spada C, Radaelli F, Savevski V, Wallace MB, Sharma P, Rösch T, Hassan C. Artificial intelligence and colonoscopy experience: lessons from two randomised trials. Gut 2022; 71:757-765. [PMID: 34187845 DOI: 10.1136/gutjnl-2021-324471] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Artificial intelligence has been shown to increase adenoma detection rate (ADR) as the main surrogate outcome parameter of colonoscopy quality. To which extent this effect may be related to physician experience is not known. We performed a randomised trial with colonoscopists in their qualification period (AID-2) and compared these data with a previously published randomised trial in expert endoscopists (AID-1). METHODS In this prospective, randomised controlled non-inferiority trial (AID-2), 10 non-expert endoscopists (<2000 colonoscopies) performed screening/surveillance/diagnostic colonoscopies in consecutive 40-80 year-old subjects using high-definition colonoscopy with or without a real-time deep-learning computer-aided detection (CADe) (GI Genius, Medtronic). The primary outcome was ADR in both groups with histology of resected lesions as reference. In a post-hoc analysis, data from this randomised controlled trial (RCT) were compared with data from the previous AID-1 RCT involving six experienced endoscopists in an otherwise similar setting. RESULTS In 660 patients (62.3±10 years; men/women: 330/330) with equal distribution of study parameters, overall ADR was higher in the CADe than in the control group (53.3% vs 44.5%; relative risk (RR): 1.22; 95% CI: 1.04 to 1.40; p<0.01 for non-inferiority and p=0.02 for superiority). Similar increases were seen in adenoma numbers per colonoscopy and in small and distal lesions. No differences were observed with regards to detection of non-neoplastic lesions. When pooling these data with those from the AID-1 study, use of CADe (RR 1.29; 95% CI: 1.16 to 1.42) and colonoscopy indication, but not the level of examiner experience (RR 1.02; 95% CI: 0.89 to 1.16) were associated with ADR differences in a multivariate analysis. CONCLUSIONS In less experienced examiners, CADe assistance during colonoscopy increased ADR and a number of related polyp parameters as compared with the control group. Experience appears to play a minor role as determining factor for ADR. TRIAL REGISTRATION NUMBER NCT:04260321.
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Affiliation(s)
- Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy .,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Nuovo Regina Margherita, Roma, Italy.,Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Loredana Correale
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | | | - Gaia Pellegatta
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Antonio Capogreco
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | | | - Gianluca Lollo
- Department of Gastroenterology and Hepatology, Università della Svizzera Italiana, Lugano, Switzerland
| | - Dhanai Di Paolo
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Matteo Badalamenti
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Elisa Ferrara
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Alessandro Fugazza
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Silvia Carrara
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Andrea Anderloni
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Emanuele Rondonotti
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Arnaldo Amato
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Andrea De Gottardi
- Department of Gastroenterology and Hepatology, Università della Svizzera Italiana, Lugano, Switzerland
| | - Cristiano Spada
- Digestive Endoscopy Unit, Poliambulanza Brescia Hospital, Brescia, Lombardia, Italy
| | - Franco Radaelli
- Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
| | - Victor Savevski
- Artificial Intelligence Research, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | | | - Prateek Sharma
- University of Kansas, Kansas City, Kansas, USA.,Endoscopy unit, University of Kansas city, Kansas city, Kansas, USA
| | - Thomas Rösch
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Cesare Hassan
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Nuovo Regina Margherita, Roma, Italy
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