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Endoscopy 2025; 57(06): 611-619
DOI: 10.1055/a-2532-9282
Original article

Leaving colorectal polyps in situ with endocytoscopy assisted by computer-aided diagnosis: a cost-effectiveness study

Natalie Halvorsen‡   ‡
1   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
2   Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
,
Ishita Barua  ‡   ‡
1   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
2   Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
,
Shin-ei Kudo
3   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
Shraddha Gulati
4   King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.
,
Masashi Misawa 
3   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
Kensaku Mori
5   Graduate School of Informatics, Nagoya University, Nagoya, Japan
,
Bu'Hussain Hayee 
4   King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.
,
Olaolu Olabintan
4   King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.
,
Jens Aksel Nilsen
1   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
2   Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
6   Department of Medicine, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
,
Svein Oskar Frigstad
6   Department of Medicine, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
,
James E. East
7   Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom
,
Amit Rastogi
8   Division of Gastroenterology, University of Kansas Medical Center, Kansas City, KS, USA
,
Cesare Hassan
9   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
10   IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Mette Kalager
1   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
2   Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
,
Magnus Løberg
1   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
2   Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
,
Øyvind Holme
1   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
2   Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
11   Department of Research, Sørlandet Hospital Health Trust, Kristiansand, Norway
,
Amyn Haji
4   King's Institute of Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK.
,
Michael Bretthauer∗   *
1   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
2   Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
,
Yuichi Mori  ∗   *
1   Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
2   Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
3   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
› Author Affiliations
Supported by: Japan Society for the Promotion of Sciencehttp://dx.doi.org/10.13039/501100001691 No. 22H03357 Supported by: European Commissionhttp://dx.doi.org/10.13039/501100000780 No. 101057099 Trial Registration: ClinicalTrials.gov Registration number (trial ID): UMIN000027360 Type of study: Prospective Cohort Multicentre Study
› Further Information
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Referred to by:

Author commentary on Natalie Halvorsen et al.Endoscopy 2025; 57(06): v20-v20
DOI: 10.1055/a-2543-6316

Corrected by:

Correction: Leaving colorectal polyps in situ with endocytoscopy assisted by computer-aided diagnosis: a cost-effectiveness studyEndoscopy 2025; 57(06): C6-C6
DOI: 10.1055/a-2548-0262

Abstract

Background Computer-aided diagnosis (CADx) enables the distinction between neoplastic and non-neoplastic polyps during colonoscopy. We aimed to estimate the patient-level benefit and harm of CADx.

Methods We conducted a comparative analysis on data from the EndoBRAIN international clinical trial, evaluating the effect of optical diagnosis during colonoscopy with and without CADx. Three hypothetical scenarios were compared: “endoscopist-alone” and “CADx-assisted” leave-in-situ strategies (leaving non-neoplastic rectosigmoid polyps ≤ 5 mm), and “total removal” (removing all detected polyps). Primary outcomes included patient-level colonoscopy-related cost and surveillance interval agreement (colorectal cancer risk category). Estimates were calculated based on national reimbursement rates and guidelines in four countries.

Results We analyzed 1134 patients (59 % men, median age 67 years) with 1716 polyps. Compared with total removal, the endoscopist-alone and CADx-assisted leave-in-situ strategies reduced the removed polyps per patient from 1.51 (95 %CI 1.48–1.54) to 1.18 (95 %CI 1.16–1.20) and 1.12 (95 %CI 1.00–1.14), respectively; however, 0.023 (95 %CI 0.015–0.033) and 0.021 (95 %CI 0.014–0.031) neoplasms per patient were left in situ, respectively. The mean colonoscopy cost decreased by $44 (endoscopist alone) and $46 (CADx assistance) in the USA, $22 and $19 in the UK, $21 and $19 in Japan, and $32 and $30 in Norway, respectively. Surveillance interval agreement decreased to 99.2 % (endoscopist alone) and 99.0 % (CADx assistance) in the USA, 99.8 % and 99.8 % in the UK, 97.9 % and 97.1 % in Japan, and 99.9 % and 99.9 % in Norway, respectively.

Conclusions Both endoscopist-alone and CADx-assisted optical diagnosis reduce colonoscopy costs. The risk of missed adenomas and surveillance interval deviations appear marginal.

‡ Joint first authors


* Joint last authors


Supplementary Material



Publication History

Received: 19 August 2024

Accepted after revision: 08 January 2025

Article published online:
25 February 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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