Abstract
Computer-aided colonoscopy (CAC) may improve polyp detection and characterization compared to traditional colonoscopy (TC). However, recent studies also reported no relevant effect on adenoma detection rate (ADR). This study evaluates the real-time polyp detection system EndoMind during screening and surveillance colonoscopy in a multicenter randomized controlled trial. From November 2021 to November 2022, 933 individuals undergoing colorectal cancer screening or post-polypectomy surveillance were recruited and randomized in five outpatient treating centers (10 examiners; >10 years of experience). 914 Patients were included in the intention to treat analysis (CAC:452, TC:462) and detected lesions were framed on the primary monitor in the CAC group. More than 94% of the examinations were screening or surveillance colonoscopies with overall similar patient characteristics. The ADR (CAC:34.5% vs TC:32.9%; p = 0.656) was not significantly different between the groups. The effect of CAC on ADR remains a controversial discussion. Diverging study setups and patient collectives complicate consistent comparisons. Future studies should focus on large-scale real-world populations. ClinicalTrials.gov:NCT05006092 (registered: 2021-08-06).
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Data availability
As required by the study's ethics vote, the datasets generated and analyzed during the current study are not publicly available due to privacy concerns but are available from the corresponding author on reasonable request. The underlying code for this study and training/validation datasets are not publicly available for proprietary reasons.
Code availability
The underlying code for this study and training/validation datasets are not publicly available for proprietary reasons.
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Acknowledgements
A.H. and W.G.Z. receive public funding for this work from the state government of Baden-Württemberg, Germany (Funding cluster Forum Gesundheitsstandort Baden-Württemberg, grant number 5-5409.0-001.01/15) to research and develop artificial intelligence applications for polyp detection in screening colonoscopy. Additional funding sources to support this work were the Eva Mayr-Stihl Foundation, Waiblingen, Germany, the Fischerwerke GmbH & Co. KG, Waldachtal, Germany, and the Dieter von Holtzbrinck Stiftung GmbH, Stuttgart, Germany. The authors acknowledge the support by Prof. J.F. Riemann, “Stiftung Lebensblicke” the Foundation for early detection of colon cancer.
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**A.H.** designed the study, drafted the manuscript, and developed the polyp detection system. **T.J.L.** designed the study, drafted the manuscript, and performed statistical analysis. **Z.S.** designed the study and drafted the manuscript. **DF** designed the study, drafted the manuscript, and developed the polyp detection system. **I.K.** performed statistical analysis. **W.B.** recruited patients, performed colonoscopy procedures, and/or participated in the data collection. **F.P.a.** recruited patients, performed colonoscopy procedures, and/or participated in the data collection. **T.H.** recruited patients, performed colonoscopy procedures, and/or participated in the data collection. **B.S.** recruited patients, performed colonoscopy procedures and/or participated in the data collection, and developed the polyp detection system. **F.J.H.** recruited patients, performed colonoscopy procedures, and/or participated in the data collection. **W.G.Z.** recruited patients, performed colonoscopy procedures, and/or participated in the data collection. **M.B.** developed the polyp detection system. **A.K.** developed the polyp detection system. **J.T.** developed the polyp detection system. **F.P.u.** developed the polyp detection system. **L.L.** critically revised the draft for important intellectual content. **A.M.** critically revised the draft for important intellectual content. **All the authors** revised and approved the final manuscript.
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T.J.L.: Research Support: Gastroenterology Foundation, Interdisziplinäres Zentrum für klinische Forschung Würzburg. Honoraria for lectures: MPC Medical Professionalist GmbH. AM: Royalties: Ovesco Endoscopy AG, Consulting fees: Ovesco Endoscopy AG, Pentax Medical, Honoraria for lectures: Falk Foundation, AbbVie, Takeda Pharmaceutical, Advisory board: Luvos Heilerde. FPa: Consulting fees: Johnson&Johnson, Support for travel: AbbVie, Participation on a Data Safety Monitoring Board or Advisory Board: Johnson&Johnson. The remaining authors have no financial, professional, or personal conflicts of interest to disclose.
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Lux, T.J., Saßmannshausen, Z., Kafetzis, I. et al. Artificial intelligence assisted colorectal lesion detection in private practices a randomized controlled study. npj Digit. Med. (2026). https://doi.org/10.1038/s41746-026-02576-8
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DOI: https://doi.org/10.1038/s41746-026-02576-8
