P4745 - AI-Assisted vs Traditional Colonoscopy in Colorectal Neoplasia Detection: A Systematic Review and Meta-Analysis of RCTs and Observational Studies

Ashesh Das, MBBS¹, Venkata Dileep Kumar Veldi, MBBS², Nadia Ahmed, MBBCh³, Saketh S. Mandiga, ⁴, Fnu Raja, MBBS⁵, Anika Chowdhury, MBBS⁶, Sri Sai Praneeth SS. Angara, ⁷, Prateek ‎, MBBS⁸, Krish Patel, MBBS⁹, Shriya D. Tayade, MBBS¹⁰, Digvijay S.. Rajawat, ¹¹, Suchith Boodegere Suresh, ¹², Sagar M. Modi, MBBS¹³, Reshmitha Kantamneni, MBBS¹⁴, Adithya Andanappa, MBBS¹⁵, Amogh Verma, MBBS¹⁶
1KPC Medical College and Hospital , Kolkata, India, Kolkata, West Bengal, India; 2Gayatri Vidya Parishad Institute of Health care and Medical Technology, Visakhapatnam, Andhra Pradesh, India; 3Faculty of Medicine, Ain Shams University, Richmond, BC, Canada; 4Osmania General Hospital and Medical College, Hyderabad, Telangana, India; 5Federal Medical and Dental College, Islamabad, Daharki, Sindh, Pakistan; 6Shaheed Suhrawardy Medical College and Hospital, Port Jefferson, NY; 7Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, Andhra Pradesh, India; 8All India Institute of Medical Science, Rishikesh, Uttarakhand, India, Rishikesh, Uttarakhand, India; 9C. U. Shah Medical College, Surendranagar, Gujarat, India; 10RAK Medical and Health Sciences University, New York, NY; 11All India Institute of Medical Sciences, Patna, Patna, Bihar, India; 12Montefiore St Luke's Cornwall Hospital, Newburgh, NY; 13Smt. NHL Municipal Medical College, Edison, NJ; 14Rangaraya medical college, Kakinada, Andhra Pradesh, India; 15Mysore Medical College and Research Institute, Mysore, Karnataka, India; 16Rama Medical College Hospital and Research Centre, Hapur, 245304, India, Hapur, Uttar Pradesh, India

Introduction: In the US, Colorectal cancer (CRC) remains a leading cause of cancer-related mortality. This systematic review and meta-analysis compare AI-assisted colonoscopy (AI-AC) to traditional colonoscopy (TC), integrating both randomized controlled trials (RCTs) and observational studies (OBS) to evaluate AI’s impact not only in controlled research settings but also in clinical practice.

Methods: A comprehensive systematic search was conducted on PubMed, Embase, Scopus, and the Cochrane Library to identify RCTs and OBS comparing AI-AC with TC for adenoma and polyp detection till March 2025. Meta-analysis was conducted using RevMan 5.4.1. For dichotomous outcomes, pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method. For continuous outcomes, mean differences (MDs) with 95% CIs were used. Random or fixed-effects models were applied based on heterogeneity, assessed using Higgins I² statistic. Statistical significance was set at p-value < 0.05. The risk of bias was assessed using the RoB 2.0 tool for RCTs and the Newcastle-Ottawa Scale for OBS.

Results: A total of 14 studies were included: 11 RCTs with 10,481 patients (5,252 AI-AC, 5,229 TC) and 3 OBS with 4,544 patients (1,756 AI-AC, 2,788 TC). Adenoma Detection Rate (ADR) was significantly higher with AI-AC in both RCTs (RR 1.41, CI 1.25–1.60, p< 0.00001) and OBS (RR 1.15, CI 1.07–1.23, p< 0.0001), with a pooled RR of 1.34 (CI 1.21–1.48, p< 0.00001). Adenomas per Colonoscopy (APC) was also higher with AI-AC, with a mean difference of 0.19 (CI 0.16–0.22, p< 0.00001) in RCTs, 0.14 (CI 0.07–0.21, p=0.0002) in OBS, and a pooled mean difference of 0.18 (CI 0.15–0.21, p< 0.00001). Polyp Detection Rate (PDR) was significantly higher in the AI-AC group in RCTs (RR 1.40, CI 1.27–1.55, p< 0.00001) but not in OBS (RR 1.02, CI 0.82–1.28, p=0.84), with a pooled RR of 1.36 (CI 1.22–1.51, p< 0.00001). AADR was higher with AI-AC in RCTs (RR 1.45, CI 0.94–2.23, p=0.09) and OBS (RR 1.56, CI 0.84–2.91, p=0.16) without statistical significance, though pooled analysis showed significant improvement (RR 1.44, CI 1.06–1.95, p=0.02).

Discussion: Results of RCTs and OBS consistently show that AI-AC significantly improves ADR, APC, PDR, and AADR compared to TC. These findings support that AI-AC enhances neoplasia detection across diverse settings and may improve screening efficacy in routine practice. Variability among studies likely reflects differences in patient populations, endoscopist experience, and AI systems.


Figure: Figure: Forest plots comparing AI-assisted colonoscopy (AI-AC) vs. traditional colonoscopy (TC) for key detection metrics.

Disclosures:
Ashesh Das indicated no relevant financial relationships.
Venkata Dileep Kumar Veldi indicated no relevant financial relationships.
Nadia Ahmed indicated no relevant financial relationships.
Saketh Mandiga indicated no relevant financial relationships.
Fnu Raja indicated no relevant financial relationships.
Anika Chowdhury indicated no relevant financial relationships.
Sri Sai Praneeth Angara indicated no relevant financial relationships.
Prateek ‎ indicated no relevant financial relationships.
Krish Patel indicated no relevant financial relationships.
Shriya Tayade indicated no relevant financial relationships.
Digvijay Rajawat indicated no relevant financial relationships.
Suchith Boodegere Suresh indicated no relevant financial relationships.
Sagar Modi indicated no relevant financial relationships.
Reshmitha Kantamneni indicated no relevant financial relationships.
Adithya Andanappa indicated no relevant financial relationships.
Amogh Verma indicated no relevant financial relationships.

Ashesh Das, MBBS¹, Venkata Dileep Kumar Veldi, MBBS², Nadia Ahmed, MBBCh³, Saketh S. Mandiga, ⁴, Fnu Raja, MBBS⁵, Anika Chowdhury, MBBS⁶, Sri Sai Praneeth SS. Angara, ⁷, Prateek ‎, MBBS⁸, Krish Patel, MBBS⁹, Shriya D. Tayade, MBBS¹⁰, Digvijay S.. Rajawat, ¹¹, Suchith Boodegere Suresh, ¹², Sagar M. Modi, MBBS¹³, Reshmitha Kantamneni, MBBS¹⁴, Adithya Andanappa, MBBS¹⁵, Amogh Verma, MBBS¹⁶. P4745 - AI-Assisted vs Traditional Colonoscopy in Colorectal Neoplasia Detection: A Systematic Review and Meta-Analysis of RCTs and Observational Studies, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.