Artificial intelligence in colonoscopy: Enhancing quality indicators for optimal patient outcomes

Table 2 Summary of systematic reviews and meta-analyses evaluating the impact of artificial intelligence on detection rate metrics in colonoscopy[18,37,40,41,43,44,46,48,50,51,55-61,108-113]

Ref.	Year	Study type	Patient number	Number of studies	Primary outcome	Artificial intelligence vs conventional colonoscopy (95%CI)
Barua et al[37]	2020	Systematic review and meta-analysis	4311	5 RCTs	ADR, PDR, APC, PPC, aAPC	ADR: 29.6% vs 19.3%; RR = 1.52 (1.31 to 1.77); PDR: 45.4% vs 30.6%; RR = 1.48 (1.37 to 1.60); No difference in aAPC; PPC: 0.93 vs 0.51; Mean difference 0.42 (0.33 to 0.50); APC: 0.41 vs 0.23; Mean difference 0.18 (0.13 to 0.22)
Aziz et al[108]	2020	Systematic review and meta-analysis	2815	3 RCTs	ADR	32.9% vs 20.8%; RR = 1.58 (1.39 to 1.80)
Mohan et al[109]	2020	Systematic review and meta-analysis	4962	6 RCTs	ADR	32.8% vs 21.1%; RR = 1.5 (1.30 to 1.72)
Ashat et al[110]	2021	Systematic review and meta-analysis	5058	6 RCTs	ADR	33.7% vs 22.9%; OR = 1.76 (1.55 to 2.00)
Hassan et al[56]	2021	Systematic review and meta-analysis	4354	5 RCTs	ADR	36.6% vs 25.2%; RR = 1.44 (1.27 to 1.62)
Deliwala et al[61]	2021	Systematic review and meta-analysis	4996	6 RCTs	ADR, PDR	ADR: OR = 1.77 (1.50 to 2.08); PDR: OR = 1.91 (1.68 to 2.16)
Nazarian et al[51]	2021	Systematic review and meta-analysis	5577 subjects for polyp detection with ADR and PDR	48 studies (18 studies for polyp detection, 22 studies for polyp characterization and 8 studies for PDR)	ADR, PDR, polyp characterization	PDR: OR = 1.75 (1.56 to 1.96); ADR: OR = 1.53 (1.32 to 1.77)
Li et al[59]	2021	Systematic review and meta-analysis	4311	5 studies	ADR, PDR	PDR: OR = 1.91 (1.68 to 2.16); ADR: OR = 1.75 (1.52 to 2.01)
Zhang et al[60]	2021	Systematic review and meta-analysis	5427	7 RCTs	ADR, PDR	PDR: OR = 1.95 (1.75 to 2.19); ADR: OR = 1.72 (1.52 to 1.95)
Spadaccini et al[48]	2021	Systematic review and network meta-analysis	34445	50 RCTs	ADR	CADe vs HD white-light endoscopy OR = 1.78 (1.44 to 2.18); CADe vs chromoendoscopy OR = 1.45 (1.14 to 1.85); CADe vs increased mucosal visualization systems OR = 1.54 (1.22 to 1.94)
Huang et al[41]	2022	Systematic review and meta-analysis	6629	10 RCTs	ADR, PDR	ADR: 35.4% vs 24.9%; RR = 1.43 (1.33 to 1.53)/OR = 1.45 (1.32 to 1.59); PDR: 48.6% vs 33.8%; RR = 1.44 (1.35 to 1.53)/OR = 1.90 (1.70 to 2.11)
Shah et al[62]	2023	Systematic review and meta-analysis	10928	14 RCTs	ADR, PDR	ADR: OR = 1.52 (1.39 to 1.67); PDR: OR = 1.48 (1.37 to 1.61)
Hassan et al[57]	2023	Systematic review and meta-analysis	18232	21 RCTs	ADR, APC, aAPC, number of serrated lesions/colonoscopy, number of polypectomies for nonneoplastic lesions, WT	ADR: 44.0% vs 35.9%; RR = 1.24 (1.16 to 1.33)
Lou et al[58]	2023	Systematic review and meta-analysis	27404	33 RCTs	ADR, APC	ADR: RR = 1.242 (1.159 to 1.332); APC: IRR = 1.390 (1.277 to 1.513)
Adiwinata et al[50]	2023	Systematic review and meta-analysis	NA	13 RCTs	ADR, PDR	PDR: OR = 1.46 (1.13 to 1.89); ADR: OR = 1.58 (1.37 to 1.82)
Shiha et al[43]	2023	Systematic review and meta-analysis	11340	12 RCTs	ADR	41.4% vs 33%; RR = 1.26 (1.18 to 1.35)
Wei et al[111]	2024	Systematic review and meta-analysis	11660	12 studies	ADR	ADR was statistically significantly higher with AI vs CC (36.3% vs 35.8%, RR = 1.13, 95%CI: 1.01 to 1.28)
Aziz et al[112]	2024	Systematic review and network meta-analysis	61172	94 RCTs	ADR	Autofluorescence imaging: RR = 1.33 (1.06 to 1.66); Dye-based chromoendoscopy: RR = 1.32 (1.17 to 1.50); Endo cuff: RR = 1.19 (1.04 to 1.35); Endo cuff vision: RR = 1.26 (1.13 to 1.41); Endoring: RR = 1.30 (1.10 to 1.52); Flexible spectral imaging color enhancement: RR = 1.26 (1.09 to 1.46); Full-spectrum endoscopy: RR = 1.40 (1.19 to 1.65); High definition: RR = 1.41 (1.28 to 1.54); Linked color imaging: RR = 1.21 (1.08 to 1.36); Narrow band imaging: RR = 1.33 (1.18 to 1.48); Water exchange: RR = 1.22 (1.06 to 1.42); Water immersion: RR = 1.47 (1.19 to 1.82)
Soleymanjahi et al[18]	2024	Systematic review and meta-analysis	36201	44 RCTs	APC, ACN	APC: 0.98 vs 0.78; IRD = 0.22 (0.16 to 0.28); ACN: 0.16 vs 0.15; IRD = 0.01 (-0.01 to 0.02)
Patel et al[46]	2024	Systematic review and meta-analysis	9782	8 non-randomized studies	ADR	44% vs 38%; RR = 1.11 (0.97 to 1.28)
Gangwani et al[113]	2024	Network meta-analysis	22560	26 studies (20 RCTs, 3 retrospective, 3 prospective studies)	ADR	AI vs single operator: RR = 1.1 (0.9 to 1.2)
Lee et al[44]	2024	Systematic review and meta-analysis	17413	24 RCTs	ADR	Tandem studies: RR = 1.18 (1.08 to 1.30); Parallel studies: RR = 1.26 (1.17 to 1.35); Overall ADR: RR = 1.24 (1.17 to 1.31)
Makar et al[40]	2025	Systematic review and meta-analysis	23861	28 RCTs	ADR	ADR: RR = 1.20 (1.14 to 1.27)
Spadaccini et al[55]	2025	Systematic review and meta-analysis	5421	10 RCTs	ADR	0.62 vs 0.52; RR = 1.19 (1.08 to 1.31)

CI: Confidence interval; RCTs: Randomized clinical trials; ADR: Adenoma detection rate; PDR: Polyp detection rate; NR: Not reported; APC: Adenomas per colonoscopy; PPC: Mean number of polyps per colonoscopy; aAPC: Mean number of advanced adenomas detected per colonoscopy; WT: Withdrawal time; ACN: Advanced colorectal neoplasia; RR: Relative risk; OR: Odds ratio; HD: High definition; CADe: Computer-aided detection; AI: Artificial intelligence; IRR: Incidence rate ratio; CC: Conventional colonoscopy; IRD: Incidence rate difference.