A retrospective cohort study evaluating the impact of computer-aided detection on adenoma and polyp detection rates among nongastroenterologist endoscopists in a rural medical center.

Background and Aims: Disproportionate increases in colorectal cancer (CRC) morbidity and mortality have been documented in rural communities, even when adjusted for race, ethnicity, and socioeconomic status. The American Society for Gastrointestinal Endoscopy recently updated colonoscopy standards by increasing adenoma detection rate (ADR) and withdrawal time (WT) recommendations. Computer-aided detection (CADe) is believed to increase ADR by a magnitude of 14.4%. Studies examining how CADe affects ADR, polyp detection rate (PDR), and WT among nongastroenterology fellowship-trained endoscopists in rural areas are absent. Our study aims to assess changes in ADR of 2 general surgeons (GSs) and 1 family medicine (FM) physician with the use of CADe in a remote Critical Access Hospital (Pullman Regional Hospital in Pullman, Wash, USA). Methods: Adults undergoing colonoscopy for the indication of CRC screening or surveillance were eligible. Patients with inadequate bowel preparation or those where the procedure was not completed were excluded from analysis. CADe was used strictly during colonoscope withdrawal. Only histologically validated adenomas were included in ADR calculations. Results: In total, 1128 colonoscopies occurred prior and 1644 after implementing CADe. The mean age was 56.66 years; 51.96% were female. With CADe, average group WT was greater than 10 minutes, and ADR increased from 30.13% to 35.77% ( Conclusions: CADe resulted in improved ADR, greater than historically published. Former studies were primarily done at large centers with fellows or board-certified gastroenterologists. Disparities in CRC screening may be addressed in rural regions by using CADe technology.