Incremental value of mucosal exposure device to computer-aided detection in colonoscopy: A meta-analysis and trial sequential analysis

Background: It is unknown if mucosal exposure device improves the adenoma detection rate (ADR) of computer-aided detection (CAD)-assisted colonoscopy. Aims: We performed a meta-analysis of randomized-controlled trials (RCTs) to compare the diagnostic outcomes of these two approaches. Methods: We identified 4 RCTs (2968 patients). ADR was the primary outcome. Advanced ADR (aADR), sessile serrated ADR (SSDR) and adenoma per colonoscopy (APC) were also compared. The results were expressed in terms of mean difference (MD) or risk ratio (RR) and 95% confidence intervals (CIs), and we used trial sequential analysis (TSA) to assess if the required information size (RIS) was reached. Results: There was no difference in terms of ADR both in the overall series (RR 1.05, 0.98-1.12; p=0.16) and in screening colonoscopy (RR 1.15, 0.72-1.82; p=0.56). Although the RIS (3829 participants) was not reached, the futility boundaries were crossed suggesting a high likelihood of futility in further comparison of ADR. No difference was observed in terms of aADR (RR 1.13, 0.90-1.44; p=0.30) and SSDR (RR 1.11, 0.92-1.35; p=0.27). APC was significantly higher in the combined group (MD 0.14, 0.05 to 0.22; p=0.002). Conclusions: The addition of mucosal exposure devices does not increase ADR, aADR, and SSDR but increases APC.