Artificial intelligence-assisted colonoscopy: excellent results, but will mucosal exposure devices push this boundary?

The quality of colonoscopy screening is frequently assessed using the adenoma detection rate (ADR); however, the number of subjects exhibiting high risk features, such as an advanced adenoma or five or more adenomas, at the index colonoscopy holds greater clinical significance, directly influencing surveillance recommendations [1]. In actual clinical settings, colonoscopy performance exhibits significant variation in the ADR and number of subjects with high risk features, potentially leading to inconsistencies in diagnostic accuracy and therapeutic effectiveness. Experience, and advancements in devices and technology can enhance the performance of endoscopists, with adequate bowel preparation serving as the foundation. Studies have indicated that computer-aided detection (CADe) systems and mucosal exposure devices, such as the Endocuff and balloon-based devices, can improve the ADR when the baseline ADR of the endoscopist is between 35% and 45% [2] [3] [4].