Long-term impact of artificial intelligence on colorectal adenoma detection in high-risk colonoscopy

Table 1 Patient demographics and procedure indication, n (%)

	Pre-AI (n = 278) (A)	Post-AI early (n = 255) (B)	Post-AI established (n = 285) (C)	Post-AI late (n = 190) (D)	P value (A vs B)	P value (A vs C)	P value (A vs D)
Age (mean ± SD)	56.7 ± 10.4	56.7 ± 10.8	57.2 ± 11.2	57.1 ± 11.2	0.99	0.60	0.68
Sex
Male	122 (43.9)	113 (44.3)	134 (47.0)	93 (48.9)	0.92	0.51	0.28
Female	156 (56.1)	142 (55.7)	151 (53.0)	97 (51.1)	0.92	0.51	0.28
Ethnicity
Asian	30 (10.7)	24 (9.4)	27 (9.5)	13 (6.8)	0.70	0.60	0.15
Black	27 (9.7)	26 (10.2)	36 (12.6)	19 (10.0)	0.85	0.27	0.92
Hispanic	181 (65.1)	172 (67.5)	178 (62.5)	134 (70.5)	0.57	0.51	0.22
White	21 (7.6)	16 (6.3)	19 (6.7)	12 (6.3)	0.56	0.68	0.61
Other	19 (6.8)	17 (6.7)	25 (8.8)	12 (6.3)	0.94	0.39	0.82
Insurance status
No insurance	29 (10.4)	41 (16.1)	24 (8.4)	25 (13.2)	0.05	0.41	0.36
Medicaid	186 (66.9)	169 (66.3)	188 (66.0)	135 (71.1)	0.87	0.81	0.34
Medicare	6 (2.2)	2 (0.8)	5 (1.8)	7 (3.7)	0.19	0.73	0.32
Medicaid + medicare	30 (10.8)	31 (12.2)	41 (14.4)	16 (8.4)	0.62	0.20	0.40
Private or other	27 (9.7)	10 (3.9)	27 (9.5)	7 (3.7)	0.01	0.92	0.01
BMI (mean ± SD)	30.2 ± 7.0	30.4 ± 6.7	30.5 ± 7.0	30.8 ± 7.6	0.78	0.65	0.42
Fellow involvement	181 (65.1)	167 (65.5)	170 (59.6)	110 (57.9)	0.93	0.18	0.11
Procedure indication1
Fecal immunochemical testing positive	95 (34.2)	97 (38.0)	79 (27.8)	58 (30.5)	0.35	0.10	0.41
Anemia	33 (11.9)	29 (11.4)	36 (12.6)	27 (14.2)	0.86	0.78	0.46
Gastrointestinal bleeding	53 (19.1)	71 (27.8)	45 (15.8)	31 (16.3)	0.02	0.31	0.45
History of polyps	46 (16.5)	31 (12.2)	37 (13.0)	25 (13.2)	0.15	0.23	0.32
Family history of colorectal cancer	15 (5.4)	21 (8.2)	10 (3.5)	8 (4.2)	0.19	0.28	0.56
Other	42 (15.1)	42 (16.5)	64 (22.5)	29 (15.3)	0.67	0.03	0.96

¹Some patients had multiple procedure indications.

Continuous comparisons used two-tailed unpaired student t-tests and categorical comparisons used two-tailed chi-squared tests. AI: Artificial intelligence.

Table 2 Colorectal cancer screening metrics before and after the implementation of artificial intelligence, n (%)

	Pre-AI (n = 278) (A)	Post-AI early (n = 255) (B)	Post-AI established (n = 285) (C)	Post-AI late (n = 190) (D)	P value(A vs B)	P value(A vs C)	P value(A vs D)
Bowel preparation quality
Excellent	111 (39.9)	106 (41.6)	95 (33.3)	63 (33.2)	0.70	0.10	0.14
Good	124 (44.6)	108 (42.4)	121 (42.5)	76 (40.0)	0.60	0.61	0.32
Fair	40 (14.4)	36 (14.1)	61 (21.4)	43 (22.6)	0.93	0.03	0.02
Unspecified	3 (1.1)	5 (2.0)	8 (2.8)	8 (4.2)	0.40	0.32	0.03
Total number of polyps detected (polyps per colonoscopy)	364 (1.3)	419 (1.6)	373 (1.3)	235 (1.2)
Total number of adenomas detected (adenomas per colonoscopy)	211 (0.8)	253 (1.0)	227 (0.8)	138 (0.7)
Polyp size
< 5 mm	236 (64.8)	277 (66.1)	277 (74.3)	161 (68.5)	0.71	0.005	0.35
5 mm-10 mm	66 (18.1)	91 (21.7)	50 (13.4)	43 (18.3)	0.21	0.08	0.96
> 10 mm	59 (16.2)	51 (12.2)	41 (11.0)	30 (12.8)	0.10	0.04	0.25
Unspecified	3 (0.8)	0 (0.0)	5 (1.3)	1 (0.4)	0.06	0.50	0.56
Polyp detection rate	166/278 (59.7)	152/255 (59.6)	161/285 (56.5)	116/190 (61.1)	0.98	0.44	0.77
Adenoma detection rate	106/278 (38.1)	107/255 (42.0)	114/285 (40.0)	75/190 (39.5)	0.37	0.65	0.77
Advanced adenoma1 detection rate	45/278 (16.2)	44/255 (17.3)	43/285 (15.1)	33/190 (17.4)	0.74	0.72	0.74
Non-neoplastic polyp2 detection rate	83/278 (30.0)	89/255 (34.9)	77/285 (27.0)	58/190 (30.5)	0.21	0.46	0.88

¹Advanced adenomas were defined as size ≥ 10 mm, presence of villous or tubulovillous features, presence of high-grade dysplasia, or ≥ adenomas.

²Non-neoplastic polyps included hyperplastic polyps, lymphoid aggregates, and colonic mucosa.

AI: Artificial intelligence.