Wallace CADe (tandem)
Impact of Artificial Intelligence on Miss Rate of Colorectal Neoplasia
Patient / Population Intervention / Exposure Comparison Outcome
In 230 patients undergoing screening or surveillance colonoscopy at eight centres in Italy, the UK and the USA, AI-assisted colonoscopy performed first reduced the adenoma miss rate at same-day tandem colonoscopy compared with standard colonoscopy performed first.
N
230
Design
International multicentre randomised tandem-colonoscopy trial (Italy, UK, USA)
Endpoint
Adenoma miss rate (AMR)
Relevance
2
ResultAMR 15.5% vs 32.4% (adjusted OR 0.38, 95% CI 0.23–0.62); effect largest for lesions ≤5 mm (15.9% vs 35.8%; OR 0.34) and nonpolypoid lesions (16.8% vs 45.8%; OR 0.24). False-negative subjects 6.8% vs 29.6% (OR 0.17, 95% CI 0.05–0.67); no difference in adverse events.
Wallace MB, et al. Gastroenterology. 2022;163(1):295-304.e5. 10.1053/j.gastro.2022.03.007
Discussion & critique
The cleanest demonstration that CADe corrects perceptual error: a roughly two-fold fall in miss rate across three countries, concentrated in small and flat lesions. Tandem design measures misses, not clinical outcomes; 230 patients; endoscopists could not be masked. Read together with Glissen Brown it explains where the ADR gains of the parallel-group trials come from.