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TOPLINE:

An automatic quality control system (AQCS) significantly improves adenoma detection rates (ADRs) during routine colonoscopy among lower- and medium-level colonoscopists and in both academic and nonacademic settings.

METHODOLOGY:

• An AQCS was developed to monitor colonoscopy phases, assess bowel preparation, and detect polyps during high-definition white-light procedures.
• Researchers aimed to evaluate the effectiveness of AQCS in improving ADRs among colonoscopists who were medium- and low-level detectors with mean basal ADRs of 25%-35% and < 25%, respectively.
• They conducted a randomized clinical trial at six centers in China, with participants randomly assigned to either standard colonoscopy or AQCS-assisted colonoscopy under identical endoscopic settings.
• The primary outcome was the ADR, defined as the proportion of individuals with one or more adenomas confirmed by histopathologic examination; secondary outcomes included advanced ADR, ADR in nonacademic and academic settings, number of adenomas per colonoscopy, and adverse events.

TAKEAWAY:

• Between August 2021 and September 2022, researchers randomized 1254 participants (mean age, 51.21 years; 46.3% women) to standard colonoscopy (n = 627) or AQCS-assisted colonoscopy (n = 627).
• The ADR was significantly higher in the AQCS-assisted colonoscopy group than in the standard colonoscopy group (32.7% vs 22.6%; relative risk [RR], 1.60; P < .001).
• AQCS significantly improved the ADRs of both lower-level (RR, 1.71; P = .001) and medium-level (RR, 1.61; P = .02) detectors.
• ACCS also improved the detection rates by 8.5% in academic centers (RR, 1.58; P = .01) and by 11.6% in nonacademic centers (RR, 1.74; P = .002).
• The number of adenomas per colonoscopy was higher in the AQCS-assisted colonoscopy group than in the standard colonoscopy group, an effect also observed among lower-level detectors, in nonacademic centers, for flat or sessile lesions, proximal colonic lesions, lesions < 10 mm, and nonadvanced adenomas.
• Mean withdrawal times were longer in the AQCS-assisted colonoscopy group, with a mean difference of 0.32 minutes for nonintervention and 0.24 minutes for negative colonoscopy.
• No serious adverse events were reported.

IN PRACTICE:

“The AQCS-assisted colonoscopy offered benefits for both moderate- and low-level detectors in both the academic and nonacademic settings and could even attenuate the influence of suboptimal colonoscopy (unqualified bowel preparation, withdrawal time < 6 minutes, or incomplete colonoscopy) on the adenoma detection rate,” the authors wrote.

SOURCE:

This study, led by Jing Liu, MD, PhD, Qilu Hospital of Shandong University in Jinan, China, was published online in JAMA Network Open.

LIMITATIONS:

Potential bias may exist as colonoscopists were not blinded to patient assignments. The link between adenoma findings by AQCS and long-term outcomes, including colorectal cancer and cost-effectiveness, remains unclear. The AQCS did not use blind spot recognition and reminders, and the absence of a control arm with only computer-aided detection limited conclusions about AQCS’s advantages. 

DISCLOSURES:

This study was supported by grants from the National Natural Science Foundation of China, Key R&D Program of Shandong Province, Taishan Scholars Program of Shandong Province, and National Key Research and Development Program of China. The authors did not disclose any relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.