Bowel preparation quality and computer-aided detection of adenomas during colonoscopy

Objectives: Computer-aided detection (CADe) systems improve adenoma detection during colonoscopy, but the influence of bowel preparation quality on CADe performance is unclear. This study assessed whether different levels of adequate bowel preparation affect CADe effectiveness. Methods: A post-hoc pooled analysis was conducted using individual patient data from three randomized controlled trials comparing CADe-assisted colonoscopy to standard colonoscopy (SC). Adenoma detection rate (ADR) and adenomas per colonoscopy (APC) were analyzed by bowel preparation quality, categorized as good (BBPS 6-7) or excellent (BBPS 8-9). Interaction analysis assessed whether bowel prep quality modified CADe effectiveness. Results: Among 2,103 patients, 43.1 % had good and 56.9 % excellent bowel preparation. CADe improved ADR over SC by + 8.4 % (95 %CI: 1.9-14.9) in patients with good preparation and by + 10.6 % (95 %CI: 5.016.2) in those with excellent preparation, with no statistically significant interaction between preparation quality levels ( A = + 2.2 %, 95 %CI: -6.4 to 10.8; interaction p = 0.612). APC also increased by + 0.28 (95 %CI: 0.06-0.50) and + 0.20 (95 %CI: 0.03-0.36), respectively ( A = -0.08 %, 95 % CI: -0.22 to + 0.06, interaction p = 0.261). Similar effects were observed for right sided and diminutive adenomas. Conclusion: CADe performances in enhancing adenoma detection, are not influenced by cleansing quality grades.