P0558 - Adenoma Prevalence With the Use of a Computer-Aided Detection Device (CADe) by Patient Demographics

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Sahin Coban, MD

University of North Dakota, School of Medicine & Health Sciences
Grand Forks, ND

Sahin Coban, MD¹, Aasma Shaukat, MD, MPH², David Lichtenstein, MD³, Yeli Wang, PhD⁴, Daniel Colucci, BS⁴, Emma Navajas, BS⁴, Shrujal Baxi, MD⁴, William Brugge, MD⁵
¹University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND; ²New York University Grossman School of Medicine, New York, NY; ³Boston Medical Center, Boston University School of Medicine, Boston, MA; ⁴Iterative Health Inc., Cambridge, MA; ⁵Mount Auburn Hospital/Harvard Medical School, Boston, MA

Introduction: In recent years, computerized-aided devices (CADe) have been successfully implemented in screening colonoscopies to detect colorectal cancer (CRC), the fourth most common cancer in the United States. While screening colonoscopies provide the best method of early detection, nearly one-fourth of colorectal neoplasms may be missed during this procedure, resulting in post-colonoscopy interval CRC. Most currently available CADe studies do not stratify by sex and age, two main demographic risk factors for CRC. This study aimed to identify the colorectal adenoma prevalence associated with age and sex with the use of a CADe device.

Methods: We performed a post-hoc analysis of the SKOUT registration study to evaluate the efficacy of a CADe. Patients were randomized to standard or CADe colonoscopy. The primary endpoint was adenomas per colonoscopy (APC). Secondary outcome measurements included adenoma detection rate (ADR) and adenomas per positive colonoscopy (APPC). In this post-hoc analysis, we compared outcome measures by age (< 65 vs. ≥65 years) and sex (male vs. female).

Results: Of 1,418 participants (standard n=710, CADe n=708), 67.1% were < 65, and 52.8% were male. Using CADe, a significant increase in mean APC was observed in comparison to the control group for participants < 65 years (0.724 vs. 0.883, P=0.029), participants ≥65 years (1.055 vs. 1.367, P=0.032), and men (1.022 vs. 1.308, P=0.009). For ADR, a significant increment was observed for men (0.478 vs. 0.547, P=0.025), and a borderline significance was observed for participants < 65 years (0.396 vs. 0.450, P=0.054). For APPC, a significant increase was observed for participants ≥65 years (2.018 vs. 2.568, P=0.009) and women (1.583 vs. 1.894, P=0.032).

Discussion: Our study found that colonoscopy quality metrics increased across demographic subgroups by age and sex with the use of CADe, with the largest increase in APC being seen in subjects ≥65 years and in males. Further studies using CADe comparing adenoma detection and post-polypectomy cancer incidence should address its effect on interval CRC in these groups. With real world application of CADe, our data on potential differences by sex and age can help to create risk-adapted screening strategies and inform benchmarks for colonoscopy quality metrics.

	Control group	CADe group mean (SD)	Difference (Treatment-Control) (95% CI)	P-value of difference	RR (Treatment vs. Control) (95% CI)	P-value of relative risk
APC
Age
< 65 years	0.724	0.883	0.159 (-0.010, 0.321)	0.029	1.22 (1.06, 1.41)	0.006
≥ 65 years	1.055	1.367	0.312 (0.006, 0.663)	0.032	1.30 (1.10, 1.53)	0.002
Sex
Male	1.022	1.308	0.286 (0.034, 0.534)	0.009	1.28 (1.12, 1.46)	< 0.001
Female	0.615	0.758	0.143 (-0.043, 0.331)	0.064	1.23 (1.03, 1.48)	0.026
ADR
Age
< 65 years	0.396	0.450	0.054 (-0.007, 0.117)	0.054	1.14 (0.94, 1.38)	0.20
≥ 65 years	0.523	0.532	0.009 (-0.083, 0.104)	0.42	1.02 (0.79, 1.31)	0.89
Sex
Male	0.478	0.547	0.069 (-0.004, 0.139)	0.069	1.14 (0.94, 1.40)	0.19
Female	0.388	0.400	0.012 (-0.060, 0.085)	0.39	1.03 (0.81, 1.31)	0.81
APPC
Age
< 65 years	1.830	1.962	0.132 (-0.152, 0.434)	0.18	1.07 (0.93, 1.24)	0.34
≥ 65 years	2.018	2.568	0.551 (0.053, 1.022)	0.009	1.27 (1.08, 1.51)	0.005
Sex
Male	2.136	2.389	0.253 (-0.090, 0.611)	0.082	1.12 (0.98, 1.28)	0.10
Female	1.583	1.894	0.311 (-0.008, 0.651)	0.032	1.20 (1.00, 1.44)	0.06

Table: Table 1. Adenoma prevalence measured by adenomas per colonoscopy (APC) according to age and sex between subgroups of different study arms.
Abbreviations: CADe, computer-aided detection; CI, confidence interval; RR, relative risk; SD, standard deviation.

Disclosures:

Sahin Coban indicated no relevant financial relationships.

Aasma Shaukat: Freenome Inc – Consultant. Iterative Health – Grant/Research Support. Medtronic – Consultant.

David Lichtenstein: ABIM – GI board committee. Ambu – Consultant. Boston Scientific Inc – Consultant. Elements Endoscopy – Advisor or Review Panel Member. Iterative Health – Advisory Committee/Board Member, Grant/Research Support. Olympus – Consultant, Speakers Bureau. Palette Life Sciences – Clinical events committee. SafeHeal – Advisory Committee/Board Member.

Yeli Wang: Iterative Health – Employee, Stock Options.

Daniel Colucci: Iterative Health – Employee, Stock Options.

Emma Navajas: Iterative Health – Employee, Stock Options.

Shrujal Baxi: Iterative Health – Employee, Stock Options.

William Brugge: Iterative Health – Advisory Committee/Board Member.

Sahin Coban, MD¹, Aasma Shaukat, MD, MPH², David Lichtenstein, MD³, Yeli Wang, PhD⁴, Daniel Colucci, BS⁴, Emma Navajas, BS⁴, Shrujal Baxi, MD⁴, William Brugge, MD⁵. P0558 - Adenoma Prevalence With the Use of a Computer-Aided Detection Device (CADe) by Patient Demographics, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.