
@article{penz_impact_2020,
	title = {Impact of adenoma detection rate on detection of advanced adenomas and endoscopic adverse events in a study of over 200,000 screening colonoscopies},
	volume = {91},
	issn = {0016-5107},
	url = {https://www.sciencedirect.com/science/article/pii/S0016510719322084},
	doi = {10.1016/j.gie.2019.08.038},
	abstract = {Background and Aims
Adenoma detection rate (ADR) is the best established quality parameter for screening colonoscopy. Guidelines recommend a target ADR {\textgreater}25\% because previous studies have shown that patients of endoscopists with higher ADRs have a lower risk of postcolonoscopy interval cancers. However, studies have shown that improvement in ADR mainly results in increased detection of clinically irrelevant nonadvanced adenomas (NAAs). The impact of ADR on the detection of advanced adenomas (AAs) as well as adverse event rates has yet to be determined.
Methods
A total of 218,193 screening colonoscopies performed between 2007 and 2010 by 262 endoscopists within the Austrian quality assurance program were analyzed. We divided endoscopists into quintiles based on ADRs and calculated mean advanced ADRs (AADRs), NAA detection rates (NAADRs), and adverse event rates for each quintile. Spearman rank-order was used to calculate overall correlations between ADRs and AADRs as well as adverse event rates. Endoscopists with an ADR {\textless}25\% were compared with those with an ADR {\textgreater}25\%.
Results
Fifty-one percent of patients were women. Mean ADR was 23.03\% (95\% confidence interval [CI], 21.93-24.13), AADRs 7.72\% (95\% CI, 7.19-8.25), and NAADRs 15.31\% (95\% CI, 14.36-16.27). Overall, there was a significant correlation between ADR and AADR (rho = .51; P {\textless} .001). When ADR was divided into quintiles, mean AADR increased with increasing ADR. Even in the highest ADR group (ADR, 31.36\%-52.27\%) there was a further increase in AADR with a mean of 10.75\% (95\% CI, 9.31-12.19). Importantly, NAADRs increased continuously with improvement in ADRs but never dissociated from a simultaneous improvement in AADRs. However, there was also a significant correlation of ADRs and endoscopic adverse events (rho = .26, P {\textless} .001), even if the perforation rate of .028\% (95\% CI, .004-.052) in the highest ADR group still remained within the accepted limits based on guidelines.
Conclusions
Increasing ADR is associated with improved detection of AAs and therefore is likely to prevent more cases of colorectal cancer. However, higher ADR was also associated with a higher rate of adverse events, although the adverse event rate was low.},
	number = {1},
	urldate = {2025-09-07},
	journal = {Gastrointestinal Endoscopy},
	author = {Penz, Daniela and Ferlitsch, Arnulf and Waldmann, Elisabeth and Irina, Gessl and Daniel, Pammer and Asaturi, Arno and Hinterberger, Anna and Majcher, Barbara and Szymanska, Aleksandra and Trauner, Michael and Ferlitsch, Monika},
	month = jan,
	year = {2020},
	pages = {135--141},
	file = {ScienceDirect Snapshot:C\:\\Users\\Tlux1\\Zotero\\storage\\UE8F2A6H\\S0016510719322084.html:text/html},
}

@article{soleymanjahi_artificial_2024,
	title = {Artificial {Intelligence}–{Assisted} {Colonoscopy} for {Polyp} {Detection}: {A} {Systematic} {Review} and {Meta}-analysis},
	volume = {177},
	copyright = {https://www.acpjournals.org/journal/aim/text-and-data-mining},
	issn = {0003-4819, 1539-3704},
	shorttitle = {Artificial {Intelligence}–{Assisted} {Colonoscopy} for {Polyp} {Detection}},
	url = {https://www.acpjournals.org/doi/10.7326/ANNALS-24-00981},
	doi = {10.7326/ANNALS-24-00981},
	language = {en},
	number = {12},
	urldate = {2025-09-07},
	journal = {Annals of Internal Medicine},
	author = {Soleymanjahi, Saeed and Huebner, Jack and Elmansy, Lina and Rajashekar, Niroop and Lüdtke, Nando and Paracha, Rumzah and Thompson, Rachel and Grimshaw, Alyssa A. and Foroutan, Farid and Sultan, Shahnaz and Shung, Dennis L.},
	month = dec,
	year = {2024},
	pages = {1652--1663},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\G9UVYNUM\\Soleymanjahi et al. - 2024 - Artificial Intelligence–Assisted Colonoscopy for Polyp Detection A Systematic Review and Meta-analy.pdf:application/pdf},
}

@article{halvorsen_benefits_2025,
	title = {Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening: microsimulation modelling study},
	volume = {4},
	copyright = {http://creativecommons.org/licenses/by-nc/4.0/},
	issn = {2754-0413},
	shorttitle = {Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colorectal cancer screening},
	url = {https://bmjmedicine.bmj.com/lookup/doi/10.1136/bmjmed-2025-001446},
	doi = {10.1136/bmjmed-2025-001446},
	abstract = {Objective
              To estimate the benefits, burden, and harms of implementing computer aided detection (CADe) of polyps in colonoscopy of population based screening programmes for colorectal cancer.
            
            
              Design
              Microsimulation modelling study.
            
            
              Setting
              Cost effectiveness working package in the OperA (optimising colorectal cancer prevention through personalised treatment with artificial intelligence) project. A parallel guideline committee panel (BMJ Rapid recommendation) was consulted in defining the screening interventions and selection of outcome measures.
            
            
              Population
              Four cohorts of 100 000 European individuals aged 60-69 years.
            
            
              Intervention
              The intervention was one screening of colonoscopy and a screening of colonoscopy after faecal immunochemical test every other year with CADe. The comparison group had the same screening every other year without CADe.
            
            
              Main outcome measures
              Benefits (colorectal cancer incidence and death), burden (surveillance colonoscopies), and harms (colonoscopy related adverse events) over 10 years were measured. The certainty in each outcome was assessed by use of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.
            
            
              Results
              For 100 000 individuals participating in colonoscopy screening, 824 (0.82\%) were diagnosed with colorectal cancer within 10 years without CADe versus 713 (0.71\%) with CADe (risk difference –0.11\% (95\% CI –0.43\% to 0.21\%)). For faecal immunochemical test screening colonoscopy, the risk was 5.82\% (n=5820) without CADe versus 5.77\% (n=5770) with CADe (difference –0.05\% (–0.33\% to 0.15\%)). The risk of surveillance colonoscopy increased from 26.45\% (n=26 453) to 32.82\% (n=32 819) (difference 6.37\% (5.8\% to 6.9\%)) for colonoscopy screening and from 52.26\% (n=52 263) to 53.08\% (n=53 082) (difference 0.82\% (0.38\% to 1.26\%)) for faecal immunochemical test screening colonoscopy. No significant differences were noted in adverse events related to the colonoscopy between CADe and no CADe. The model estimates were sensitive to the assumed effects of screening on colorectal cancer risk and of CADe on adenoma detection rates. All outcomes were graded as low certainty.
            
            
              Conclusion
              With low certainty of evidence, adoption of CADe in population based screening provides small and uncertain clinical meaningful benefit, no incremental harms, and increased surveillance burden after screening.},
	language = {en},
	number = {1},
	urldate = {2025-09-07},
	journal = {BMJ Medicine},
	author = {Halvorsen, Natalie and Hassan, Cesare and Correale, Loredana and Pilonis, Nastazja and Helsingen, Lise M and Spadaccini, Marco and Repici, Alessandro and Foroutan, Farid and Olav Vandvik, Per and Sultan, Shanaz and Løberg, Magnus and Kalager, Mette and Mori, Yuichi and Bretthauer, Michael},
	month = mar,
	year = {2025},
	pages = {e001446},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\PHUTJFP9\\Halvorsen et al. - 2025 - Benefits, burden, and harms of computer aided polyp detection with artificial intelligence in colore.pdf:application/pdf},
}

@article{sultan_aga_2025,
	title = {{AGA} {Living} {Clinical} {Practice} {Guideline} on {Computer}-{Aided} {Detection}–{Assisted} {Colonoscopy}},
	volume = {168},
	issn = {00165085},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S0016508525000356},
	doi = {10.1053/j.gastro.2025.01.002},
	language = {en},
	number = {4},
	urldate = {2025-09-07},
	journal = {Gastroenterology},
	author = {Sultan, Shahnaz and Shung, Dennis L. and Kolb, Jennifer M. and Foroutan, Farid and Hassan, Cesare and Kahi, Charles J. and Liang, Peter S. and Levin, Theodore R. and Siddique, Shazia Mehmood and Lebwohl, Benjamin},
	month = apr,
	year = {2025},
	pages = {691--700},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\SVU2A9V5\\Sultan et al. - 2025 - AGA Living Clinical Practice Guideline on Computer-Aided Detection–Assisted Colonoscopy.pdf:application/pdf},
}

@article{bretthauer_use_2025,
	title = {Use of computer-assisted detection ({CADe}) colonoscopy in colorectal cancer screening and surveillance: {European} {Society} of {Gastrointestinal} {Endoscopy} ({ESGE}) {Position} {Statement}},
	volume = {57},
	issn = {0013-726X, 1438-8812},
	shorttitle = {Use of computer-assisted detection ({CADe}) colonoscopy in colorectal cancer screening and surveillance},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/a-2543-0370},
	doi = {10.1055/a-2543-0370},
	abstract = {AND RECOMMENDATION This statement conveys the European Society of Gastrointestinal Endoscopy (ESGE) position on the use of computeraided detection (CADe) with artificial intelligence (AI) during colonoscopy for colorectal cancer (CRC) screening or surveillance. The ESGE position is informed by the BMJ Rapid Recommendation initiative and the approach of the MAGIC Evidence Ecosystem Foundation; these include systematic reviews of currently available evidence, supplemented by microsimulation modeling and patient values and preferences, for the benefits and harms of AI CADe devices during colonoscopy.},
	language = {en},
	number = {06},
	urldate = {2025-09-07},
	journal = {Endoscopy},
	author = {Bretthauer, Michael and Ahmed, Jabed and Antonelli, Giulio and Beaumont, Hanneke and Beg, Sabina and Benson, Ariel and Bisschops, Raf and De Cristofaro, Elena and Gibbons, Eimear and Häfner, Michael and Karsenti, David and Laquière, Arthur and Loly, Jean-Philippe and O’Reilly, Susanne M. and Pellisé, Maria and Grubelic Ravic, Katja and Triantafyllou, Konstantinos and Tziatzios, Georgios and Valente, Roberto and Walter, Benjamin M. and Wiesand, Malina and Lorenzo-Zúñiga, Vicente and Gralnek, Ian Mark},
	month = jun,
	year = {2025},
	pages = {667--673},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\PRERZISF\\Bretthauer et al. - 2025 - Use of computer-assisted detection (CADe) colonoscopy in colorectal cancer screening and surveillanc.pdf:application/pdf},
}

@article{budzyn_endoscopist_2025,
	title = {Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study},
	volume = {10},
	issn = {24681253},
	shorttitle = {Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S2468125325001335},
	doi = {10.1016/S2468-1253(25)00133-5},
	abstract = {Background It is not known if continuous exposure to artificial intelligence (AI) changes endoscopists’ behaviour when conducting colonoscopy. We assessed how endoscopists who regularly used AI performed colonoscopy when AI was not in use.},
	language = {en},
	number = {10},
	urldate = {2025-09-07},
	journal = {The Lancet Gastroenterology \& Hepatology},
	author = {Budzyń, Krzysztof and Romańczyk, Marcin and Kitala, Diana and Kołodziej, Paweł and Bugajski, Marek and Adami, Hans O and Blom, Johannes and Buszkiewicz, Marek and Halvorsen, Natalie and Hassan, Cesare and Romańczyk, Tomasz and Holme, Øyvind and Jarus, Krzysztof and Fielding, Shona and Kunar, Melina and Pellise, Maria and Pilonis, Nastazja and Kamiński, Michał Filip and Kalager, Mette and Bretthauer, Michael and Mori, Yuichi},
	month = oct,
	year = {2025},
	pages = {896--903},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\849KPAMN\\Budzyń et al. - 2025 - Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy a multicentre,.pdf:application/pdf},
}

@article{wiest_deep_2024,
	title = {Deep sight: enhancing periprocedural adverse event recording in endoscopy by structuring text documentation with privacy-preserving large language models},
	volume = {3},
	issn = {2949-7086},
	shorttitle = {Deep sight},
	url = {https://www.sciencedirect.com/science/article/pii/S2949708624001067},
	doi = {10.1016/j.igie.2024.08.001},
	abstract = {Background and Aims
The assessment of adverse events from endoscopic procedures is essential for successful interventions, ensuring accurate follow-up, adverse event management, and processing for quality control. Despite the critical need for structured documentation, the current practice often relies on free-text recordings, which poses challenges for scalable intervention analysis; however, the introduction of large language models (LLMs) offers a promising solution by enabling the automatic extraction of adverse event details from procedural reports without altering existing documentation practices.
Methods
We analyzed 672 endoscopy reports, using OpenAI’s GPT-4 and Llama-2–based models to structure the data in JavaScript Object Notation for efficient analysis. We used an automated LLM pipeline to extract adverse events such as bleeding, perforation, and aspiration. The dataset was divided into a proof-of-concept set (PoC-S) with n = 171 reports, on which we explored prompt engineering to improve the performance of the models. The final analysis was run on an additional external test set of 501 reports.
Results
GPT-4 showed high accuracy, with a sensitivity of 97\% and specificity of 92\% in the PoC-S and 91\% and 96\%, respectively, in the test set. GPT-4 use in real-world settings is limited by privacy concerns. Conversely, Llama-2–based models, especially the Llama-2 variants fine-tuned for German language, demonstrated comparable performance (PoC-S: sensitivity of 94\%; specificity of 92\%, in the test set (TS): sensitivity of 89\%; specificity of 93\%) and offered a viable privacy-compliant alternative. The model effectiveness was further influenced by the method of prompt engineering, with experiments showing that the specificity and sensitivity could vary substantially based on the inclusion of specific prompt features, underscoring the importance of tailored prompt design.
Conclusions
Applying LLMs to extract structured medical information, particularly from endoscopy reports, offers an efficient, scalable, and adaptable documentation method that captures adverse events accurately with a low error rate. It facilitates immediate quality reporting and reduces manual documentation efforts.},
	number = {4},
	urldate = {2025-07-25},
	journal = {iGIE},
	author = {Wiest, Isabella C. and Ferber, Dyke and Wittlinger, Stefan and Ebert, Matthias P. and Belle, Sebastian and Kather, Jakob Nikolas},
	month = dec,
	year = {2024},
	pages = {447--452.e5},
	file = {ScienceDirect Snapshot:C\:\\Users\\Tlux1\\Zotero\\storage\\R7EF5LX7\\S2949708624001067.html:text/html},
}

@article{uraoka_sanos_2011,
	title = {Sano's {Capillary} {Pattern} {Classification} for {Narrow}-{Band} {Imaging} of {Early} {Colorectal} {Lesions}},
	volume = {23},
	copyright = {© 2011 The Authors. Digestive Endoscopy © 2011 Japan Gastroenterological Endoscopy Society},
	issn = {1443-1661},
	url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1443-1661.2011.01118.x},
	doi = {10.1111/j.1443-1661.2011.01118.x},
	abstract = {Narrow-band imaging enhances visualization of the mucosal surface structure and vascular network and helps to increase the visibility of neoplasia by improving contrast. Sano and his colleagues first reported its efficacy for endoscopic use in the gastrointestinal tract and later proposed a sequential classification of the mucosal vascular network patterns according to histopathological categories. Sano's ‘capillary pattern classification’ was established to facilitate diagnosis of early colorectal lesions on a step-by-step basis. This review focuses on the utility and effectiveness of Sano's capillary pattern classification when examining early colorectal lesions using narrow-band imaging.},
	language = {en},
	number = {s1},
	urldate = {2025-07-25},
	journal = {Digestive Endoscopy},
	author = {Uraoka, Toshio and Saito, Yutaka and Ikematsu, Hiroaki and Yamamoto, Kazuhide and Sano, Yasushi},
	year = {2011},
	note = {\_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1443-1661.2011.01118.x},
	keywords = {capillary pattern, colonoscopy, narrow-band imaging (NBI), Sano classification},
	pages = {112--115},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\TIHG57RE\\Uraoka et al. - 2011 - Sano's Capillary Pattern Classification for Narrow-Band Imaging of Early Colorectal Lesions.pdf:application/pdf;Snapshot:C\:\\Users\\Tlux1\\Zotero\\storage\\RH54N9B8\\j.1443-1661.2011.01118.html:text/html},
}

@article{oka_therapeutic_2009,
	title = {Therapeutic strategy for colorectal laterally spreading tumor},
	volume = {21 Suppl 1},
	issn = {1443-1661},
	doi = {10.1111/j.1443-1661.2009.00869.x},
	abstract = {Most colorectal tumors larger than 20 mm in diameter are called laterally spreading tumors (LST), most of which are adenomatous lesions. Laterally spreading tumors are classified into two types according to their morphology, granular type (LST-G) and non-granular type (LST-NG). Each type has two subtypes. The former consists of a 'homogenous type' and a 'nodular mixed type', while the latter consists of a 'flat elevated (FE) type' and a 'psedodepressed (PD) type'. In LST-G and LST-NG FE types, type V pit pattern with magnification enables the recognition of the carcinomatous or submucosal invasive area. Most of these adenomatous large lesions can be cured by scheduled endoscopic piecemeal mucosal resection (EPMR). However, LST-G with large whole nodular type or type V pit pattern, which cannot be resected en bloc with a snare, is an indication for endoscopic submucosal dissection (ESD). The LST-NG PD has a high frequency of submucosal invasion and the submucosal invasive area cannot be recognized correctly in the pseudodepression with magnification prior to endoscopic treatment. Therefore, en bloc resection with ESD should be applied to LST-NG PD. The therapeutic strategy for choosing between EPMR and ESD for large LST lesions should therefore be determined based on the macroscopic findings of their subtype and pit pattern findings.},
	language = {eng},
	journal = {Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society},
	author = {Oka, Shiro and Tanaka, Shinji and Kanao, Hiroyuki and Oba, Sayaka and Chayama, Kazuaki},
	month = jul,
	year = {2009},
	pmid = {19691733},
	keywords = {Colonoscopy, Colorectal Neoplasms, Humans, Intestinal Mucosa, Neoplasm Invasiveness},
	pages = {S43--46},
}

@article{kobayashi_diagnostic_2019,
	title = {Diagnostic yield of the {Japan} {NBI} {Expert} {Team} ({JNET}) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database},
	volume = {7},
	issn = {2050-6406},
	url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683640/},
	doi = {10.1177/2050640619845987},
	abstract = {Background
Magnifying Narrow Band Imaging (NBI) during colonoscopy is a reliable method for differential and depth diagnoses of colorectal lesions. This study examined the diagnostic yield of magnifying NBI based on the Japan NBI Expert Team (JNET) classification in a clinical setting using a large-scale clinical practice database. Types 1, 2A, 2B and 3 correspond to the histopathological classifications of hyperplastic polyp/sessile-serrated polyp, low-grade intramucosal neoplasia, high-grade intramucosal neoplasia/shallow submucosal invasive cancer, and deep submucosal invasive cancer, respectively.

Methods
The prospective records of colonoscopy reports and pathological data of 1558 consecutive superficial colorectal lesions removed by colonoscopy were retrospectively analysed. After excluding 156 lesions, the documented JNET classifications of the remaining 1402 colorectal lesions were analysed. Diagnostic yield was analysed and also compared between expert endoscopists and nonexpert endoscopists.

Results
The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were respectively 75\%, 96\%, 74\%, 96\% and 93\% for type 1; 91\%, 70\%, 92\%, 67\% and 87\% for type 2A; 42\%, 95\%, 26\%, 98\% and 93\% for type 2B; and 35\%, 100\%, 93\%, 98\% and 98\% for type 3. Nonexpert and expert endoscopists alike had specificity, NPV and accuracy {\textgreater}90\% for types 1, 2B and 3, and a sensitivity and PPV {\textgreater}90\% for type 2A. Type 2B had a low sensitivity of 42\% because it included various histological features.

Conclusions
The JNET classification proved useful in a clinical setting both for expert and nonexpert endoscopists, as was expected from the original JNET definition, but type 2B requires further investigation using pit pattern diagnosis.},
	number = {7},
	urldate = {2025-07-25},
	journal = {United European Gastroenterology Journal},
	author = {Kobayashi, Shunsuke and Yamada, Masayoshi and Takamaru, Hiroyuki and Sakamoto, Taku and Matsuda, Takahisa and Sekine, Shigeki and Igarashi, Yoshinori and Saito, Yutaka},
	month = aug,
	year = {2019},
	pmid = {31428416},
	pmcid = {PMC6683640},
	pages = {914--923},
	file = {Full Text:C\:\\Users\\Tlux1\\Zotero\\storage\\Y9UURGMV\\Kobayashi et al. - 2019 - Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of supe.pdf:application/pdf},
}

@article{brule_colorectal_2022,
	title = {The {COlorectal} {NEoplasia} {Endoscopic} {Classification} to {Choose} the {Treatment} classification for identification of large laterally spreading lesions lacking submucosal carcinomas: {A} prospective study of 663 lesions},
	volume = {10},
	issn = {2050-6406},
	shorttitle = {The {COlorectal} {NEoplasia} {Endoscopic} {Classification} to {Choose} the {Treatment} classification for identification of large laterally spreading lesions lacking submucosal carcinomas},
	url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8830277/},
	doi = {10.1002/ueg2.12194},
	abstract = {Introduction
Optical diagnosis is necessary when selecting the resection modality for large superficial colorectal lesions. The COlorectal NEoplasia Endoscopic Classification to Choose the Treatment (CONECCT) encompasses overt (irregular pit or vascular pattern) and covert (macroscopic features) signs of carcinoma in an all‐in‐one classification using validated criteria. The CONECCT IIC subtype corresponds to adenomas with a high risk of superficial carcinoma that should be resected en bloc with free margins.

Methods
This prospective multicentre study investigated the diagnostic accuracy of the CONECCT classification for predicting submucosal invasion in colorectal lesions {\textgreater}20 mm. Optical diagnosis before en bloc resection by endoscopic submucosal dissection (ESD) was compared with the final histological diagnosis. Diagnostic accuracy for the CONECCT IIC subtype was compared with literature‐validated features of concern considered to be risk factors for submucosal invasion (non‐granular large spreading tumour [NG LST], macronodule {\textgreater}1 cm, SANO IIIA area, and Paris 0‐IIC area).

Results
Six hundred 63 lesions removed by ESD were assessed. The en bloc, R0, and curative resection rates were respectively 96\%, 85\%, and 81\%. The CONECCT classification had a sensitivity (Se) of 100\%, specificity (Sp) of 26.2\%, positive predictive value of 11.6\%, and negative predictive value (NPV) of 100\% for predicting at least submucosal adenocarcinoma. The sensitivity of CONECCT IIC (100\%) to predict submucosal cancer was superior to all other criteria evaluated. COlorectal NEoplasia Endoscopic Classification to Choose the Treatment IIC lesions constituted 11.5\% of all submucosal carcinomas.

Conclusion
The CONECCT classification, which combines covert and overt signs of carcinoma, identifies with very perfect sensitivity (Se 100\%, NPV 100\%) the 30\% of low‐risk adenomas in large laterally spreading lesions treatable by piecemeal endoscopic mucosal resection or ESD according to expertise without undertreatment. However, the low specificity of CONECCT leads to a large number of potentially not indicated ESDs for suspected high‐risk lesions.},
	number = {1},
	urldate = {2025-07-25},
	journal = {United European Gastroenterology Journal},
	author = {Brule, Clementine and Pioche, Mathieu and Albouys, Jeremie and Rivory, Jerome and Geyl, Sophie and Legros, Romain and Rostain, Florian and Dahan, Martin and Lepetit, Hugo and Sautereau, Denis and Ponchon, Thierry and Auditeau, Emilie and Jacques, Jeremie},
	month = jan,
	year = {2022},
	pmid = {35089651},
	pmcid = {PMC8830277},
	pages = {80--92},
	file = {Full Text:C\:\\Users\\Tlux1\\Zotero\\storage\\FIXRFGKT\\Brule et al. - 2022 - The COlorectal NEoplasia Endoscopic Classification to Choose the Treatment classification for identi.pdf:application/pdf},
}

@article{lux_endoscopic_2023,
	title = {Endoscopic treatment of a {Fabry} disease‐related, lumen‐obstructing colonic tumor},
	volume = {11},
	issn = {2050-6406},
	url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493349/},
	doi = {10.1002/ueg2.12418},
	number = {7},
	urldate = {2025-07-15},
	journal = {United European Gastroenterology Journal},
	author = {Lux, Thomas Joachim and Meining, Alexander},
	month = may,
	year = {2023},
	pmid = {37248789},
	pmcid = {PMC10493349},
	pages = {690--691},
	file = {PubMed Central Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\M3I7L82Q\\Lux and Meining - 2023 - Endoscopic treatment of a Fabry disease‐related, lumen‐obstructing colonic tumor.pdf:application/pdf},
}

@article{lux_closing_2024,
	title = {Closing the {Gap}: {A} {Critical} {Examination} of {Adherence}, {Inconsistency}, and {Improvements} in {Colonoscopy} {Reporting} {Practices}},
	volume = {105},
	issn = {0012-2823},
	shorttitle = {Closing the {Gap}},
	url = {https://doi.org/10.1159/000538113},
	doi = {10.1159/000538113},
	abstract = {Introduction: Comprehensive and standardized colonoscopy reports are crucial in colorectal cancer prevention, monitoring, and research. This study investigates adherence to national and international guidelines by analyzing reporting practices among 21 endoscopists in 7 German centers, with a focus on polyp reporting. Methods: We identified and assessed German, European, American, and World Health Organization-provided statements to identify key elements in colonoscopy reporting. Board-certified gastroenterologists rated the relevance of each element and estimated their reporting frequency. Adherence to the identified report elements was evaluated for 874 polyps from 351 colonoscopy reports ranging from March 2021 to March 2022. Results: We identified numerous recommendations for colonoscopy reporting. We categorized the reasoning behind those recommendations into clinical relevance, justification, and quality control and research. Although all elements were considered relevant by the surveyed gastroenterologists, discrepancies were observed in the evaluated reports. Particularly diminutive polyps or attributes which are rarely abnormal (e.g., surface integrity) respectively rarely performed (e.g., injection) were sparsely documented. Furthermore, the white light morphology of polyps was inconsistently documented using either the Paris classification or free text. In summary, the analysis of 874 reported polyps revealed heterogeneous adherence to the recommendations, with reporting frequencies ranging from 3\% to 89\%. Conclusion: The inhomogeneous report practices may result from implicit reporting practices and recommendations with varying clinical relevance. Future recommendations should clearly differentiate between clinical relevance and research and quality control or explanatory purposes. Additionally, the role of computer-assisted documentation should be further evaluated to increase report frequencies of non-pathological findings and diminutive polyps.},
	number = {3},
	urldate = {2025-07-15},
	journal = {Digestion},
	author = {Lux, Thomas J. and Herold, Katja and Kafetzis, Ioannis and Sodmann, Phillip and Sassmanshausen, Zita and Meining, Alexander and Hann, Alexander},
	month = mar,
	year = {2024},
	pages = {224--231},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\2CVN796J\\Lux et al. - 2024 - Closing the Gap A Critical Examination of Adherence, Inconsistency, and Improvements in Colonoscopy.pdf:application/pdf;Snapshot:C\:\\Users\\Tlux1\\Zotero\\storage\\XPNVWD5H\\000538113.html:text/html},
}

@article{buendgens_weakly_2022,
	title = {Weakly supervised end-to-end artificial intelligence in gastrointestinal endoscopy},
	volume = {12},
	copyright = {2022 The Author(s)},
	issn = {2045-2322},
	url = {https://www.nature.com/articles/s41598-022-08773-1},
	doi = {10.1038/s41598-022-08773-1},
	abstract = {Artificial intelligence (AI) is widely used to analyze gastrointestinal (GI) endoscopy image data. AI has led to several clinically approved algorithms for polyp detection, but application of AI beyond this specific task is limited by the high cost of manual annotations. Here, we show that a weakly supervised AI can be trained on data from a clinical routine database to learn visual patterns of GI diseases without any manual labeling or annotation. We trained a deep neural network on a dataset of N = 29,506 gastroscopy and N = 18,942 colonoscopy examinations from a large endoscopy unit serving patients in Germany, the Netherlands and Belgium, using only routine diagnosis data for the 42 most common diseases. Despite a high data heterogeneity, the AI system reached a high performance for diagnosis of multiple diseases, including inflammatory, degenerative, infectious and neoplastic diseases. Specifically, a cross-validated area under the receiver operating curve (AUROC) of above 0.70 was reached for 13 diseases, and an AUROC of above 0.80 was reached for two diseases in the primary data set. In an external validation set including six disease categories, the AI system was able to significantly predict the presence of diverticulosis, candidiasis, colon and rectal cancer with AUROCs above 0.76. Reverse engineering the predictions demonstrated that plausible patterns were learned on the level of images and within images and potential confounders were identified. In summary, our study demonstrates the potential of weakly supervised AI to generate high-performing classifiers and identify clinically relevant visual patterns based on non-annotated routine image data in GI endoscopy and potentially other clinical imaging modalities.},
	language = {en},
	number = {1},
	urldate = {2025-07-15},
	journal = {Scientific Reports},
	author = {Buendgens, Lukas and Cifci, Didem and Ghaffari Laleh, Narmin and van Treeck, Marko and Koenen, Maria T. and Zimmermann, Henning W. and Herbold, Till and Lux, Thomas Joachim and Hann, Alexander and Trautwein, Christian and Kather, Jakob Nikolas},
	month = mar,
	year = {2022},
	note = {Publisher: Nature Publishing Group},
	keywords = {Colonoscopy, Diagnostic markers, Image processing, Machine learning, Oesophagogastroscopy},
	pages = {4829},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\L6LS98YG\\Buendgens et al. - 2022 - Weakly supervised end-to-end artificial intelligence in gastrointestinal endoscopy.pdf:application/pdf},
}

@article{lux_assisted_2023,
	title = {Assisted documentation as a new focus for artificial intelligence in endoscopy: the precedent of reliable withdrawal time and image reporting},
	volume = {55},
	copyright = {https://creativecommons.org/licenses/by/4.0/},
	issn = {0013-726X, 1438-8812},
	shorttitle = {Assisted documentation as a new focus for artificial intelligence in endoscopy},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/a-2122-1671},
	doi = {10.1055/a-2122-1671},
	abstract = {Background Reliable documentation is essential for maintaining quality standards in endoscopy; however, in clinical practice, report quality varies. We developed an artificial intelligence (AI)-based prototype for the measurement of withdrawal and intervention times, and automatic photodocumentation.},
	language = {en},
	number = {12},
	urldate = {2025-07-15},
	journal = {Endoscopy},
	author = {Lux, Thomas J. and Saßmannshausen, Zita and Kafetzis, Ioannis and Sodmann, Philipp and Herold, Katja and Sudarevic, Boban and Schmitz, Rüdiger and Zoller, Wolfram G. and Meining, Alexander and Hann, Alexander},
	month = dec,
	year = {2023},
	note = {Publisher: Georg Thieme Verlag KG},
	pages = {1118--1123},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\H5DVTSHS\\Lux et al. - 2023 - Assisted documentation as a new focus for artificial intelligence in endoscopy the precedent of rel.pdf:application/pdf},
}

@article{lux_pilot_2022,
	title = {Pilot study of a new freely available computer-aided polyp detection system in clinical practice},
	volume = {37},
	copyright = {https://creativecommons.org/licenses/by/4.0},
	issn = {1432-1262},
	url = {https://link.springer.com/10.1007/s00384-022-04178-8},
	doi = {10.1007/s00384-022-04178-8},
	abstract = {Purpose Computer-aided polyp detection (CADe) systems for colonoscopy are already presented to increase adenoma detection rate (ADR) in randomized clinical trials. Those commercially available closed systems often do not allow for data collection and algorithm optimization, for example regarding the usage of different endoscopy processors. Here, we present the first clinical experiences of a, for research purposes publicly available, CADe system.
Methods We developed an end-to-end data acquisition and polyp detection system named EndoMind. Examiners of four centers utilizing four different endoscopy processors used EndoMind during their clinical routine. Detected polyps, ADR, time to first detection of a polyp (TFD), and system usability were evaluated (NCT05006092).
Results During 41 colonoscopies, EndoMind detected 29 of 29 adenomas in 66 of 66 polyps resulting in an ADR of 41.5\%. Median TFD was 130 ms (95\%-CI, 80–200 ms) while maintaining a median false positive rate of 2.2\% (95\%-CI, 1.7–2.8\%). The four participating centers rated the system using the System Usability Scale with a median of 96.3 (95\%-CI, 70–100).
Conclusion EndoMind’s ability to acquire data, detect polyps in real-time, and high usability score indicate substantial practical value for research and clinical practice. Still, clinical benefit, measured by ADR, has to be determined in a prospective randomized controlled trial.},
	language = {en},
	number = {6},
	urldate = {2025-07-15},
	journal = {International Journal of Colorectal Disease},
	author = {Lux, Thomas J. and Banck, Michael and Saßmannshausen, Zita and Troya, Joel and Krenzer, Adrian and Fitting, Daniel and Sudarevic, Boban and Zoller, Wolfram G. and Puppe, Frank and Meining, Alexander and Hann, Alexander},
	month = jun,
	year = {2022},
	note = {Publisher: Springer Science and Business Media LLC},
	pages = {1349--1354},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\HLV9WI3U\\Lux et al. - 2022 - Pilot study of a new freely available computer-aided polyp detection system in clinical practice.pdf:application/pdf},
}

@article{henniger_reducing_2023,
	title = {Reducing scope 3 carbon emissions in gastrointestinal endoscopy: results of the prospective study of the ‘{Green} {Endoscopy} {Project} {Würzburg}’},
	copyright = {http://creativecommons.org/licenses/by-nc/4.0/},
	issn = {0017-5749, 1468-3288},
	shorttitle = {Reducing scope 3 carbon emissions in gastrointestinal endoscopy},
	url = {https://gut.bmj.com/lookup/doi/10.1136/gutjnl-2023-331024},
	doi = {10.1136/gutjnl-2023-331024},
	abstract = {Objective Carbon emissions generated by gastrointestinal endoscopy have been recognised as a critical issue. Scope 3 emissions are mainly caused by the manufacturing, packaging and transportation of purchased goods. However, to our knowledge, there are no prospective data on the efficacy of measurements aimed to reduce scope 3 emissions. Design The study was performed in a medium-sized academic endoscopy unit. Manufacturers of endoscopic consumables were requested to answer a questionnaire on fabrication, origin, packaging and transport. Based on these data, alternative products were purchased whenever possible. In addition, staff was instructed on how to avoid waste. Thereafter, the carbon footprint of each item purchased was calculated from February to May 2023 (intervention period), and scope 3 emissions were compared with the same period of the previous year (control period).
Results 26 of 40 companies answered the questionnaire. 229 of 322 products were classified as unfavourable. A switch to alternative items was possible for 47/229 items (20.5\%). 1666 endoscopies were performed during the intervention period compared with 1751 examinations during the control period (−4.1\%). The number of instruments used decreased by 10.0\% (3111 vs 3457). Using fewer and alternative products resulted in 11.5\% less carbon emissions (7.09 vs 8.01 tons of carbon equivalent=tCO2 e). Separation of waste led to a reduction of 20.1\% (26.55 vs 33.24 tCO2e). In total, carbon emissions could be reduced by 18.4\%.
Conclusion Use of fewer instruments per procedure, recycling packaging material and switching to alternative products can reduce carbon emissions without impairing the endoscopic workflow.},
	language = {en},
	urldate = {2025-07-15},
	journal = {Gut},
	author = {Henniger, Dorothea and Lux, Thomas and Windsheimer, Max and Brand, Markus and Weich, Alexander and Kudlich, Theodor and Schöttker, Katrin and Hann, Alexander and Meining, Alexander},
	month = oct,
	year = {2023},
	note = {Publisher: BMJ},
	pages = {gutjnl--2023--331024},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\RRLKER6F\\Henniger et al. - 2023 - Reducing scope 3 carbon emissions in gastrointestinal endoscopy results of the prospective study of.pdf:application/pdf},
}

@article{brand_development_2022,
	title = {Development and evaluation of a deep learning model to improve the usability of polyp detection systems during interventions},
	volume = {10},
	issn = {2050-6414},
	url = {https://onlinelibrary.wiley.com/doi/abs/10.1002/ueg2.12235},
	doi = {10.1002/ueg2.12235},
	abstract = {Background The efficiency of artificial intelligence as computer-aided detection (CADe) systems for colorectal polyps has been demonstrated in several randomized trials. However, CADe systems generate many distracting detections, especially during interventions such as polypectomies. Those distracting CADe detections are often induced by the introduction of snares or biopsy forceps as the systems have not been trained for such situations. In addition, there are a significant number of non-false but not relevant detections, since the polyp has already been previously detected. All these detections have the potential to disturb the examiner's work. Objectives Development and evaluation of a convolutional neuronal network that recognizes instruments in the endoscopic image, suppresses distracting CADe detections, and reliably detects endoscopic interventions. Methods A total of 580 different examination videos from 9 different centers using 4 different processor types were screened for instruments and represented the training dataset (519,856 images in total, 144,217 contained a visible instrument). The test dataset included 10 full-colonoscopy videos that were analyzed for the recognition of visible instruments and detections by a commercially available CADe system (GI Genius, Medtronic). Results The test dataset contained 153,623 images, 8.84\% of those presented visible instruments (12 interventions, 19 instruments used). The convolutional neuronal network reached an overall accuracy in the detection of visible instruments of 98.59\%. Sensitivity and specificity were 98.55\% and 98.92\%, respectively. A mean of 462.8 frames containing distracting CADe detections per colonoscopy were avoided using the convolutional neuronal network. This accounted for 95.6\% of all distracting CADe detections. Conclusions Detection of endoscopic instruments in colonoscopy using artificial intelligence technology is reliable and achieves high sensitivity and specificity. Accordingly, the new convolutional neuronal network could be used to reduce distracting CADe detections during endoscopic procedures. Thus, our study demonstrates the great potential of artificial intelligence technology beyond mucosal assessment.},
	language = {en},
	number = {5},
	urldate = {2025-07-15},
	journal = {United European Gastroenterology Journal},
	author = {Brand, Markus and Troya, Joel and Krenzer, Adrian and Saßmannshausen, Zita and Zoller, Wolfram G. and Meining, Alexander and Lux, Thomas J. and Hann, Alexander},
	year = {2022},
	note = {\_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1002/ueg2.12235},
	keywords = {colonoscopy, CADe, deep learning, instrument, intervention},
	pages = {477--484},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\QSHCXSKF\\Brand et al. - 2022 - Development and evaluation of a deep learning model to improve the usability of polyp detection syst.pdf:application/pdf;Snapshot:C\:\\Users\\Tlux1\\Zotero\\storage\\TNQU6SDD\\ueg2.html:text/html},
}

@article{lux_regional_2019,
	title = {Regional {Differences} in {Tight} {Junction} {Protein} {Expression} in the {Blood}–{DRG} {Barrier} and {Their} {Alterations} after {Nerve} {Traumatic} {Injury} in {Rats}},
	volume = {21},
	copyright = {https://creativecommons.org/licenses/by/4.0/},
	issn = {1422-0067},
	url = {https://www.mdpi.com/1422-0067/21/1/270},
	doi = {10.3390/ijms21010270},
	abstract = {The nervous system is shielded by special barriers. Nerve injury results in blood–nerve barrier breakdown with downregulation of certain tight junction proteins accompanying the painful neuropathic phenotype. The dorsal root ganglion (DRG) consists of a neuron-rich region (NRR, somata of somatosensory and nociceptive neurons) and a ﬁbre-rich region (FRR), and their putative epi-/perineurium (EPN). Here, we analysed blood–DRG barrier (BDB) properties in these physiologically distinct regions in Wistar rats after chronic constriction injury (CCI). Cldn5, Cldn12, and Tjp1 (rats) mRNA were downregulated 1 week after traumatic nerve injury. Claudin-1 immunoreactivity (IR) found in the EPN, claudin-19-IR in the FRR, and ZO-1-IR in FRR-EPN were unaltered after CCI. However, laser-assisted, vessel speciﬁc qPCR, and IR studies conﬁrmed a signiﬁcant loss of claudin-5 in the NRR. The NRR was three-times more permeable compared to the FRR for high and low molecular weight markers. NRR permeability was not further increased 1-week after CCI, but signiﬁcantly more CD68+ macrophages had migrated into the NRR. In summary, NRR and FRR are diﬀerent in naïve rats. Short-term traumatic nerve injury leaves the already highly permeable BDB in the NRR unaltered for small and large molecules. Claudin-5 is downregulated in the NRR. This could facilitate macrophage invasion, and thereby neuronal sensitisation and hyperalgesia. Targeting the stabilisation of claudin-5 in microvessels and the BDB barrier could be a future approach for neuropathic pain therapy.},
	language = {en},
	number = {1},
	urldate = {2025-07-15},
	journal = {International Journal of Molecular Sciences},
	author = {Lux, Thomas J. and Hu, Xiawei and Ben-Kraiem, Adel and Blum, Robert and Chen, Jeremy Tsung-Chieh and Rittner, Heike L.},
	month = dec,
	year = {2019},
	note = {Publisher: MDPI AG},
	pages = {270},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\U6JTGT4A\\Lux et al. - 2019 - Regional Differences in Tight Junction Protein Expression in the Blood–DRG Barrier and Their Alterat.pdf:application/pdf},
}

@article{henniger_assessment_2023,
	title = {Assessment of the yearly carbon emission of a gastrointestinal endoscopy unit},
	volume = {72},
	copyright = {http://creativecommons.org/licenses/by-nc/4.0/},
	issn = {0017-5749, 1468-3288},
	url = {https://gut.bmj.com/lookup/doi/10.1136/gutjnl-2023-329940},
	doi = {10.1136/gutjnl-2023-329940},
	language = {en},
	number = {10},
	urldate = {2025-07-15},
	journal = {Gut},
	author = {Henniger, Dorothea and Windsheimer, Max and Beck, Hans and Brand, Markus and Lux, Thomas and Hann, Alexander and Meining, Alexander},
	month = oct,
	year = {2023},
	note = {Publisher: BMJ},
	pages = {1816--1818},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\7FHQD7EW\\Henniger et al. - 2023 - Assessment of the yearly carbon emission of a gastrointestinal endoscopy unit.pdf:application/pdf},
}

@article{dannhauser_antinociceptive_2020,
	title = {Antinociceptive modulation by the adhesion {GPCR} {CIRL} promotes mechanosensory signal discrimination},
	volume = {9},
	issn = {2050-084X},
	url = {https://doi.org/10.7554/eLife.56738},
	doi = {10.7554/eLife.56738},
	abstract = {Adhesion-type GPCRs (aGPCRs) participate in a vast range of physiological processes. Their frequent association with mechanosensitive functions suggests that processing of mechanical stimuli may be a common feature of this receptor family. Previously, we reported that the Drosophila aGPCR CIRL sensitizes sensory responses to gentle touch and sound by amplifying signal transduction in low-threshold mechanoreceptors (Scholz et al., 2017). Here, we show that Cirl is also expressed in high-threshold mechanical nociceptors where it adjusts nocifensive behaviour under physiological and pathological conditions. Optogenetic in vivo experiments indicate that CIRL lowers cAMP levels in both mechanosensory submodalities. However, contrasting its role in touch-sensitive neurons, CIRL dampens the response of nociceptors to mechanical stimulation. Consistent with this finding, rat nociceptors display decreased Cirl1 expression during allodynia. Thus, cAMP-downregulation by CIRL exerts opposing effects on low-threshold mechanosensors and high-threshold nociceptors. This intriguing bipolar action facilitates the separation of mechanosensory signals carrying different physiological information.},
	urldate = {2025-07-15},
	journal = {eLife},
	author = {Dannhäuser, Sven and Lux, Thomas J and Hu, Chun and Selcho, Mareike and Chen, Jeremy T-C and Ehmann, Nadine and Sachidanandan, Divya and Stopp, Sarah and Pauls, Dennis and Pawlak, Matthias and Langenhan, Tobias and Soba, Peter and Rittner, Heike L and Kittel, Robert J},
	editor = {Bellen, Hugo J and White, Richard M and Venkatachalm, Kartik and Dickman, Dion K},
	month = sep,
	year = {2020},
	note = {Publisher: eLife Sciences Publications, Ltd},
	keywords = {adhesion-GPCR, mechanosensory physiology, nociception},
	pages = {e56738},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\PQUP5BC9\\Dannhäuser et al. - 2020 - Antinociceptive modulation by the adhesion GPCR CIRL promotes mechanosensory signal discrimination.pdf:application/pdf},
}

@article{sudarevic_artificial_2023,
	title = {Artificial intelligence-based polyp size measurement in gastrointestinal endoscopy using the auxiliary waterjet as a reference},
	volume = {55},
	copyright = {https://creativecommons.org/licenses/by-nc-nd/4.0/},
	issn = {0013-726X, 1438-8812},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/a-2077-7398},
	doi = {10.1055/a-2077-7398},
	abstract = {Background Measurement of colorectal polyp size during endoscopy is mainly performed visually. In this work, we propose a novel polyp size measurement system (Poseidon) based on artificial intelligence (AI) using the auxiliary waterjet as a measurement reference.},
	language = {en},
	number = {09},
	urldate = {2025-07-15},
	journal = {Endoscopy},
	author = {Sudarevic, Boban and Sodmann, Philipp and Kafetzis, Ioannis and Troya, Joel and Lux, Thomas J. and Saßmannshausen, Zita and Herlod, Katja and Schmidt, Stefan A. and Brand, Markus and Schöttker, Katrin and Zoller, Wolfram G. and Meining, Alexander and Hann, Alexander},
	month = sep,
	year = {2023},
	note = {Publisher: Georg Thieme Verlag KG},
	pages = {871--876},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\XGVHAF5I\\Sudarevic et al. - 2023 - Artificial intelligence-based polyp size measurement in gastrointestinal endoscopy using the auxilia.pdf:application/pdf},
}

@article{reinhold_quantitative_2018,
	title = {Quantitative and {Microstructural} {Changes} of the {Blood}-{Nerve} {Barrier} in {Peripheral} {Neuropathy}},
	volume = {12},
	issn = {1662-453X},
	url = {https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2018.00936/full},
	doi = {10.3389/fnins.2018.00936},
	abstract = {Peripheral neuropathy is accompanied by changes in the neuronal environment. The blood-nerve barrier (BNB) is crucial in protecting the neural homeostasis: Tight junctions (TJ) seal paracellular spaces and thus prevent external stimuli from entering. In different models of neuropathic pain, the BNB is impaired, thus contributing to local damage, immune cells invasion and, ultimately, the development of neuropathy with its symptoms. In this study, we examined changes in expression and microstructural localization of two key tight junction proteins (TJP), claudin-1 and the cytoplasmic anchoring ZO-1, in the sciatic nerve of mice subjected to chronic constriction injury (CCI). Via qPCR and analysis of fluorescence immunohistochemistry, a marked downregulation of mRNA as well as decreased fluorescence intensity were observed in the nerve for both proteins. Moreover, a distinct zig-zag structure for both proteins located at cell-cell contacts, indicative of the localization of TJs, was observed in the perineurial compartment of sham-operated animals. This microstructural location in cell-cell-contacts was lost in neuropathy as semiquantified via computational analysis, based on a novel algorithm. In summary, we provide evidence that peripheral neuropathy is not only associated with decrease in relevant TJPs but also exhibits alterations in TJP arrangement and loss in barrier tightness, presumably due to internalization. Specifically, semiquantification of TJP in cell-cell-contacts of microcompartments could be used in the future for routine clinical samples of patients with neuropathy.},
	language = {English},
	urldate = {2025-07-15},
	journal = {Frontiers in Neuroscience},
	author = {Reinhold, Ann Kristin and Schwabe, Joachim and Lux, Thomas J. and Salvador, Ellaine and Rittner, Heike L.},
	month = dec,
	year = {2018},
	note = {Publisher: Frontiers},
	keywords = {Chronic constriction injury (CCI), claudin 1, neuropathic pain, Neuropathy, Tight junction (TJ), ZO-1},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\S7D5ZTEC\\Reinhold et al. - 2018 - Quantitative and Microstructural Changes of the Blood-Nerve Barrier in Peripheral Neuropathy.pdf:application/pdf},
}

@article{bretthauer_effect_2022,
	title = {Effect of {Colonoscopy} {Screening} on {Risks} of {Colorectal} {Cancer} and {Related} {Death}},
	volume = {387},
	issn = {0028-4793},
	doi = {10.1056/NEJMoa2208375},
	number = {17},
	journal = {New England Journal of Medicine},
	author = {Bretthauer, Michael and Løberg, Magnus and Wieszczy, Paulina and Kalager, Mette and Emilsson, Louise and Garborg, Kjetil and Rupinski, Maciej and Dekker, Evelien and Spaander, Manon and Bugajski, Marek and Holme, Øyvind and Zauber, Ann G. and Pilonis, Nastazja D. and Mroz, Andrzej and Kuipers, Ernst J. and Shi, Joy and Hernán, Miguel A. and Adami, Hans-Olov and Regula, Jaroslaw and Hoff, Geir and Kaminski, Michal F.},
	month = oct,
	year = {2022},
	pmid = {36214590},
	note = {publisher: Massachusetts Medical Society
\_eprint: https://doi.org/10.1056/NEJMoa2208375},
	pages = {1547--1556},
}

@article{brenner_effect_2014,
	title = {Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies},
	volume = {348},
	issn = {1756-1833},
	shorttitle = {Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality},
	doi = {10.1136/bmj.g2467},
	abstract = {Objectives To review, summarise, and compare the evidence for effectiveness of screening sigmoidoscopy and screening colonoscopy in the prevention of colorectal cancer occurrence and deaths.
Design Systematic review and meta-analysis of randomised controlled trials and observational studies.
Data sources PubMed, Embase, and Web of Science. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings.
Eligibility criteria Randomised controlled trials and observational studies in English on the impact of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality in the general population at average risk.
Results For screening sigmoidoscopy, four randomised controlled trials and 10 observational studies were identified that consistently found a major reduction in distal but not proximal colorectal cancer incidence and mortality. Summary estimates of reduction in distal colorectal cancer incidence and mortality were 31\% (95\% confidence intervals 26\% to 37\%) and 46\% (33\% to 57\%) in intention to screen analysis, 42\% (29\% to 53\%) and 61\% (27\% to 79\%) in per protocol analysis of randomised controlled trials, and 64\% (50\% to 74\%) and 66\% (38\% to 81\%) in observational studies. For screening colonoscopy, evidence was restricted to six observational studies, the results of which suggest tentatively an even stronger reduction in distal colorectal cancer incidence and mortality, along with a significant reduction in mortality from cancer of the proximal colon. Indirect comparisons of results of observational studies on screening sigmoidoscopy and colonoscopy suggest a 40\% to 60\% lower risk of incident colorectal cancer and death from colorectal cancer after screening colonoscopy even though this incremental risk reduction was statistically significant for deaths from cancer of the proximal colon only.
Conclusions Compelling and consistent evidence from randomised controlled trials and observational studies suggests that screening sigmoidoscopy and screening colonoscopy prevent most deaths from distal colorectal cancer. Observational studies suggest that colonoscopy compared with flexible sigmoidoscopy decreases mortality from cancer of the proximal colon. This added value should be examined in further research and weighed against the higher costs, discomfort, complication rates, capacities needed, and possible differences in compliance.},
	language = {en},
	journal = {BMJ},
	author = {Brenner, Hermann and Stock, Christian and Hoffmeister, Michael},
	month = apr,
	year = {2014},
	pmid = {24922745},
	note = {publisher: British Medical Journal Publishing Group
section: Research},
	pages = {g2467},
}

@article{fitzpatrick-lewis_screening_2016,
	title = {Screening for {Colorectal} {Cancer}: {A} {Systematic} {Review} and {Meta}-{Analysis}},
	volume = {15},
	issn = {15330028},
	shorttitle = {Screening for {Colorectal} {Cancer}},
	doi = {10.1016/j.clcc.2016.03.003},
	language = {en},
	number = {4},
	journal = {Clinical Colorectal Cancer},
	author = {Fitzpatrick-Lewis, Donna and Ali, Muhammad Usman and Warren, Rachel and Kenny, Meghan and Sherifali, Diana and Raina, Parminder},
	month = dec,
	year = {2016},
	pages = {298--313},
}

@article{barclay_colonoscopic_2006,
	title = {Colonoscopic {Withdrawal} {Times} and {Adenoma} {Detection} during {Screening} {Colonoscopy}},
	volume = {355},
	issn = {0028-4793},
	doi = {10.1056/NEJMoa055498},
	abstract = {In this study of 12 experienced gastroenterologists who performed colonoscopic screening, the duration of withdrawal of the colonoscope varied widely among physicians. Rates of detection of polyps were higher among endoscopists who took more time. These findings suggest that the effectiveness of colonoscopy in preventing colon cancer may be influenced by procedure times.},
	number = {24},
	journal = {New England Journal of Medicine},
	author = {Barclay, Robert L. and Vicari, Joseph J. and Doughty, Andrea S. and Johanson, John F. and Greenlaw, Roger L.},
	month = dec,
	year = {2006},
	pmid = {17167136},
	note = {publisher: Massachusetts Medical Society
\_eprint: https://doi.org/10.1056/NEJMoa055498},
	pages = {2533--2541},
}

@article{shaukat_longer_2015,
	title = {Longer {Withdrawal} {Time} {Is} {Associated} {With} a {Reduced} {Incidence} of {Interval} {Cancer} {After} {Screening} {Colonoscopy}},
	volume = {149},
	issn = {00165085},
	doi = {10.1053/j.gastro.2015.06.044},
	language = {en},
	number = {4},
	journal = {Gastroenterology},
	author = {Shaukat, Aasma and Rector, Thomas S. and Church, Timothy R. and Lederle, Frank A. and Kim, Adam S. and Rank, Jeffery M. and Allen, John I.},
	month = oct,
	year = {2015},
	pages = {952--957},
}

@article{waldmann_interval_2021,
	title = {Interval cancer after colonoscopy in the {Austrian} {National} {Screening} {Programme}: influence of physician and patient factors},
	volume = {70},
	issn = {0017-5749, 1468-3288},
	shorttitle = {Interval cancer after colonoscopy in the {Austrian} {National} {Screening} {Programme}},
	doi = {10.1136/gutjnl-2019-319427},
	abstract = {Objective Postscreening colorectal cancer (PSCRC) after screening colonoscopy is associated with endoscopists’ performance and characteristics of resected lesions. Prior studies have shown that adenoma detection rate (ADR) is a decisive factor for PSCRC, but correlations with other parameters need further analysis and ADR may change over time.
Design Cohort study including individuals undergoing screening colonoscopy between 1/2008 and 12/2019 performed by physicians participating in a quality assurance programme in Austria. Data were linked with hospitalisation data for the diagnosis of PSCRC (defined as CRC diagnosis {\textgreater}6 months after colonoscopy). ADR was defined dynamically in relation to the time point of subsequent colonoscopies; high-risk groups of patients were those with an adenoma ≥10 mm, or with high-grade dysplasia, or villous or tubulovillous histology, or a serrated lesion ≥10 mm or with dysplasia, or colonoscopies with ≥3 lesions. Main outcome was PSCRC for each risk group (negative colonoscopy, hyperplastic polyps, low-risk and high-risk group of patients) after colonoscopy by endoscopists with an ADR {\textless}20\% compared with endoscopists with an ADR ≥20\%.
Results 352 685 individuals were included in the study (51.0\% women, median age 60 years) of which 10.5\% were classified as high-risk group. During a median follow-up of 55.4 months, 241 (0.06\%) PSCRC were identified; of 387 participating physicians, 19.6\% had at least one PSCRC (8.4\% two or more). While higher endoscopist ADR decreased PSCRC incidence (HR per 1\% increase 0.97, 95\% CI 0.95 to 0.98), affiliation to the high-risk group of patients was also associated with higher PSCRC incidence (HR 3.27, 95\% CI 2.36 to 4.00). Similar correlations were seen with regards to high-risk, and advanced adenomas. The risk for PSCRC was significantly higher after colonoscopy by an endoscopist with an ADR {\textless}20\% as compared with an endoscopist with an ADR ≥20\% in patients after negative colonoscopy (HR 2.01, 95\% CI 1.35 to 3.0, p{\textless}0.001) and for the high-risk group of patients (HR 2.51, 95\% CI 1.49 to 4.22, p{\textless}0.001).
Conclusion A dynamic calculation of the ADR takes into account changes over time but confirms the correlation of ADR and interval cancer. Both lesion characteristics and endoscopists ADR may play a similar role for the risk of PSCRC. This should be considered in deciding about appropriate surveillance intervals in the future.},
	language = {en},
	number = {7},
	journal = {Gut},
	author = {Waldmann, Elisabeth and Penz, Daniela and Šinkovec, Hana and Heinze, Georg and Rinner, Christoph and Jiricka, Lena and Majcher, Barbara and Hinterberger, Anna and Trauner, Michael and Ferlitsch, Monika},
	month = jul,
	year = {2021},
	pmid = {33023903},
	note = {publisher: BMJ Publishing Group
section: Endoscopy},
	pages = {1309--1317},
}

@article{wang_effect_2020,
	title = {Effect of a deep-learning computer-aided detection system on adenoma detection during colonoscopy ({CADe}-{DB} trial): a double-blind randomised study},
	volume = {5},
	issn = {2468-1253, 2468-1156},
	shorttitle = {Effect of a deep-learning computer-aided detection system on adenoma detection during colonoscopy ({CADe}-{DB} trial)},
	doi = {10.1016/S2468-1253(19)30411-X},
	language = {English},
	number = {4},
	journal = {The Lancet Gastroenterology \& Hepatology},
	author = {Wang, Pu and Liu, Xiaogang and Berzin, Tyler M. and Brown, Jeremy R. Glissen and Liu, Peixi and Zhou, Chao and Lei, Lei and Li, Liangping and Guo, Zhenzhen and Lei, Shan and Xiong, Fei and Wang, Han and Song, Yan and Pan, Yan and Zhou, Guanyu},
	month = apr,
	year = {2020},
	pmid = {31981517},
	note = {publisher: Elsevier},
	pages = {343--351},
}

@article{hassan_new_2020,
	title = {New artificial intelligence system: first validation study versus experienced endoscopists for colorectal polyp detection},
	volume = {69},
	issn = {1468-3288},
	shorttitle = {New artificial intelligence system},
	doi = {10.1136/gutjnl-2019-319914},
	language = {eng},
	number = {5},
	journal = {Gut},
	author = {Hassan, Cesare and Wallace, Michael B. and Sharma, Prateek and Maselli, Roberta and Craviotto, Vincenzo and Spadaccini, Marco and Repici, Alessandro},
	month = may,
	year = {2020},
	pmid = {31615835},
	pages = {799--800},
}

@article{antonelli_current_2023,
	title = {Current and future implications of artificial intelligence in colonoscopy},
	volume = {36},
	issn = {1108-7471},
	doi = {10.20524/aog.2023.0781},
	abstract = {Gastrointestinal endoscopy has proved to be a perfect context for the development of artificial intelligence (AI) systems that can aid endoscopists in many tasks of their daily activities. Lesion detection (computer-aided detection, CADe) and lesion characterization (computer-aided characterization, CADx) during colonoscopy are the clinical applications of AI in gastroenterology for which by far the most evidence has been published. Indeed, they are the only applications for which more than one system has been developed by different companies, is currently available on the market, and may be used in clinical practice. Both CADe and CADx, alongside hopes and hypes, come with potential drawbacks, limitations and dangers that must be known, studied and researched as much as the optimal uses of these machines, aiming to stay one step ahead of the possible misuse of what will always be an aid to the clinician and never a substitute. An AI revolution in colonoscopy is on the way, but the potential uses are infinite and only a fraction of them have currently been studied. Future applications can be designed to ensure all aspects of colonoscopy quality parameters and truly deliver a standardization of practice, regardless of the setting in which the procedure is performed. In this review, we cover the available clinical evidence on AI applications in colonoscopy and offer an overview of future directions.},
	number = {2},
	journal = {Annals of Gastroenterology},
	author = {Antonelli, Giulio and Rizkala, Tommy and Iacopini, Federico and Hassan, Cesare},
	year = {2023},
	pmid = {36864946},
	pmcid = {PMC9932855},
	pages = {114--122},
}

@article{liu_single-monitor_2020,
	title = {The single-monitor trial: an embedded {CADe} system increased adenoma detection during colonoscopy: a prospective randomized study},
	volume = {13},
	issn = {1756-283X},
	shorttitle = {The single-monitor trial},
	doi = {10.1177/1756284820979165},
	abstract = {Background: Computer-aided detection (CADe) of colon polyps has been demonstrated to improve colon polyp and adenoma detection during colonoscopy by indicating the location of a given polyp on a parallel monitor. The aim of this study was to investigate whether embedding the CADe system into the primary colonoscopy monitor may serve to increase polyp and adenoma detection, without increasing physician fatigue level.
Methods: Consecutive patients presenting for colonoscopies were prospectively randomized to undergo routine colonoscopy with or without the assistance of a real-time polyp detection CADe system. Fatigue level was evaluated from score 0 to 10 by the performing endoscopists after each colonoscopy procedure. The main outcome was adenoma detection rate (ADR).
Results: Out of 790 patients analyzed, 397 were randomized to routine colonoscopy (control group), and 393 to a colonoscopy with computer-aided diagnosis (CADe group). The ADRs were 20.91\% and 29.01\%, respectively (OR = 1.546, 95\% CI 1.116-2.141, p = 0.009). The average number of adenomas per colonoscopy (APC) was 0.29 and 0.48, respectively (Change Folds = 1.64, 95\% CI 1.299-2.063, p {\textless} 0.001). The improvement in polyp detection was mainly due to increased detection of non-advanced diminutive adenomas, serrated adenoma and hyperplastic polyps. The fatigue score for each procedure was 3.28 versus 3.40 for routine and CADe group, p = 0.357.
Conclusions: A real-time CADe system employed on the primary endoscopy monitor may lead to improvements in ADR and polyp detection rate without increasing fatigue level during colonoscopy. The integration of a low-latency and high-performance CADe systems may serve as an effective quality assurance tool during colonoscopy. www.chictr.org.cn number, ChiCTR1800018058.},
	language = {eng},
	journal = {Therapeutic Advances in Gastroenterology},
	author = {Liu, Peixi and Wang, Pu and Glissen Brown, Jeremy R. and Berzin, Tyler M. and Zhou, Guanyu and Liu, Weihui and Xiao, Xun and Chen, Ziyang and Zhang, Zhihong and Zhou, Chao and Lei, Lei and Xiong, Fei and Li, Liangping and Liu, Xiaogang},
	year = {2020},
	pmid = {33403003},
	pmcid = {PMC7745558},
	pages = {1756284820979165},
}

@article{lux_pilot_2022-1,
	title = {Pilot study of a new freely available computer-aided polyp detection system in clinical practice},
	issn = {1432-1262},
	url = {https://doi.org/10.1007/s00384-022-04178-8},
	doi = {10.1007/s00384-022-04178-8},
	abstract = {Computer-aided polyp detection (CADe) systems for colonoscopy are already presented to increase adenoma detection rate (ADR) in randomized clinical trials. Those commercially available closed systems often do not allow for data collection and algorithm optimization, for example regarding the usage of different endoscopy processors. Here, we present the first clinical experiences of a, for research purposes publicly available, CADe system.},
	language = {en},
	urldate = {2022-05-13},
	journal = {International Journal of Colorectal Disease},
	author = {Lux, Thomas J. and Banck, Michael and Saßmannshausen, Zita and Troya, Joel and Krenzer, Adrian and Fitting, Daniel and Sudarevic, Boban and Zoller, Wolfram G. and Puppe, Frank and Meining, Alexander and Hann, Alexander},
	month = may,
	year = {2022},
}

@article{chino_performance_2023,
	title = {Performance evaluation of a computer‐aided polyp detection system with artificial intelligence for colonoscopy},
	issn = {0915-5635, 1443-1661},
	doi = {10.1111/den.14578},
	language = {en},
	journal = {Digestive Endoscopy},
	author = {Chino, Akiko and Ide, Daisuke and Abe, Seiichiro and Yoshinaga, Shigetaka and Ichimasa, Katsuro and Kudo, Toyoki and Ninomiya, Yuki and Oka, Shiro and Tanaka, Shinji and Igarashi, Masahiro},
	month = jun,
	year = {2023},
	pages = {den.14578},
}

@article{kamba_reducing_2021,
	title = {Reducing adenoma miss rate of colonoscopy assisted by artificial intelligence: a multicenter randomized controlled trial},
	volume = {56},
	issn = {1435-5922},
	shorttitle = {Reducing adenoma miss rate of colonoscopy assisted by artificial intelligence},
	doi = {10.1007/s00535-021-01808-w},
	abstract = {We have developed the computer-aided detection (CADe) system using an original deep learning algorithm based on a convolutional neural network for assisting endoscopists in detecting colorectal lesions during colonoscopy. The aim of this study was to clarify whether adenoma miss rate (AMR) could be reduced with CADe assistance during screening and surveillance colonoscopy.},
	language = {en},
	number = {8},
	journal = {Journal of Gastroenterology},
	author = {Kamba, Shunsuke and Tamai, Naoto and Saitoh, Iduru and Matsui, Hiroaki and Horiuchi, Hideka and Kobayashi, Masakuni and Sakamoto, Taku and Ego, Mai and Fukuda, Akihiro and Tonouchi, Aya and Shimahara, Yuki and Nishikawa, Masako and Nishino, Haruo and Saito, Yutaka and Sumiyama, Kazuki},
	month = aug,
	year = {2021},
	pages = {746--757},
}

@article{wang_development_2018,
	title = {Development and validation of a deep-learning algorithm for the detection of polyps during colonoscopy},
	volume = {2},
	issn = {2157-846X},
	doi = {10.1038/s41551-018-0301-3},
	abstract = {The detection and removal of precancerous polyps via colonoscopy is the gold standard for the prevention of colon cancer. However, the detection rate of adenomatous polyps can vary significantly among endoscopists. Here, we show that a machine-learning algorithm can detect polyps in clinical colonoscopies, in real time and with high sensitivity and specificity. We developed the deep-learning algorithm by using data from 1,290 patients, and validated it on newly collected 27,113 colonoscopy images from 1,138 patients with at least one detected polyp (per-image-sensitivity, 94.38\%; per-image-specificity, 95.92\%; area under the receiver operating characteristic curve, 0.984), on a public database of 612 polyp-containing images (per-image-sensitivity, 88.24\%), on 138 colonoscopy videos with histologically confirmed polyps (per-image-sensitivity of 91.64\%; per-polyp-sensitivity, 100\%), and on 54 unaltered full-range colonoscopy videos without polyps (per-image-specificity, 95.40\%). By using a multi-threaded processing system, the algorithm can process at least 25 frames per second with a latency of 76.80 ± 5.60 ms in real-time video analysis. The software may aid endoscopists while performing colonoscopies, and help assess differences in polyp and adenoma detection performance among endoscopists.},
	language = {eng},
	number = {10},
	journal = {Nature Biomedical Engineering},
	author = {Wang, Pu and Xiao, Xiao and Glissen Brown, Jeremy R. and Berzin, Tyler M. and Tu, Mengtian and Xiong, Fei and Hu, Xiao and Liu, Peixi and Song, Yan and Zhang, Di and Yang, Xue and Li, Liangping and He, Jiong and Yi, Xin and Liu, Jingjia and Liu, Xiaogang},
	month = oct,
	year = {2018},
	pmid = {31015647},
	pages = {741--748},
}

@article{misawa_development_2021,
	title = {Development of a computer-aided detection system for colonoscopy and a publicly accessible large colonoscopy video database (with video)},
	volume = {93},
	issn = {1097-6779},
	doi = {10.1016/j.gie.2020.07.060},
	abstract = {BACKGROUND AND AIMS: Artificial intelligence (AI)-assisted polyp detection systems for colonoscopic use are currently attracting attention because they may reduce the possibility of missed adenomas. However, few systems have the necessary regulatory approval for use in clinical practice. We aimed to develop an AI-assisted polyp detection system and to validate its performance using a large colonoscopy video database designed to be publicly accessible.
METHODS: To develop the deep learning-based AI system, 56,668 independent colonoscopy images were obtained from 5 centers for use as training images. To validate the trained AI system, consecutive colonoscopy videos taken at a university hospital between October 2018 and January 2019 were searched to construct a database containing polyps with unbiased variance. All images were annotated by endoscopists according to the presence or absence of polyps and the polyps' locations with bounding boxes.
RESULTS: A total of 1405 videos acquired during the study period were identified for the validation database, 797 of which contained at least 1 polyp. Of these, 100 videos containing 100 independent polyps and 13 videos negative for polyps were randomly extracted, resulting in 152,560 frames (49,799 positive frames and 102,761 negative frames) for the database. The AI showed 90.5\% sensitivity and 93.7\% specificity for frame-based analysis. The per-polyp sensitivities for all, diminutive, protruded, and flat polyps were 98.0\%, 98.3\%, 98.5\%, and 97.0\%, respectively.
CONCLUSIONS: Our trained AI system was validated with a new large publicly accessible colonoscopy database and could identify colorectal lesions with high sensitivity and specificity. (Clinical trial registration number: UMIN 000037064.).},
	language = {eng},
	number = {4},
	journal = {Gastrointestinal Endoscopy},
	author = {Misawa, Masashi and Kudo, Shin-Ei and Mori, Yuichi and Hotta, Kinichi and Ohtsuka, Kazuo and Matsuda, Takahisa and Saito, Shoichi and Kudo, Toyoki and Baba, Toshiyuki and Ishida, Fumio and Itoh, Hayato and Oda, Masahiro and Mori, Kensaku},
	month = apr,
	year = {2021},
	pmid = {32745531},
	pages = {960--967.e3},
}

@article{kroner_artificial_2021,
	title = {Artificial intelligence in gastroenterology: {A} state-of-the-art review},
	volume = {27},
	issn = {2219-2840},
	shorttitle = {Artificial intelligence in gastroenterology},
	doi = {10.3748/wjg.v27.i40.6794},
	abstract = {The development of artificial intelligence (AI) has increased dramatically in the last 20 years, with clinical applications progressively being explored for most of the medical specialties. The field of gastroenterology and hepatology, substantially reliant on vast amounts of imaging studies, is not an exception. The clinical applications of AI systems in this field include the identification of premalignant or malignant lesions (e.g., identification of dysplasia or esophageal adenocarcinoma in Barrett's esophagus, pancreatic malignancies), detection of lesions (e.g., polyp identification and classification, small-bowel bleeding lesion on capsule endoscopy, pancreatic cystic lesions), development of objective scoring systems for risk stratification, predicting disease prognosis or treatment response [e.g., determining survival in patients post-resection of hepatocellular carcinoma), determining which patients with inflammatory bowel disease (IBD) will benefit from biologic therapy], or evaluation of metrics such as bowel preparation score or quality of endoscopic examination. The objective of this comprehensive review is to analyze the available AI-related studies pertaining to the entirety of the gastrointestinal tract, including the upper, middle and lower tracts; IBD; the hepatobiliary system; and the pancreas, discussing the findings and clinical applications, as well as outlining the current limitations and future directions in this field.},
	language = {eng},
	number = {40},
	journal = {World Journal of Gastroenterology},
	author = {Kröner, Paul T. and Engels, Megan Ml and Glicksberg, Benjamin S. and Johnson, Kipp W. and Mzaik, Obaie and Hooft, Jeanin E. and Wallace, Michael B. and El-Serag, Hashem B. and Krittanawong, Chayakrit},
	month = oct,
	year = {2021},
	pmid = {34790008},
	pmcid = {PMC8567482},
	pages = {6794--6824},
}

@article{hassan_real-time_2023,
	title = {Real-{Time} {Computer}-{Aided} {Detection} of {Colorectal} {Neoplasia} {During} {Colonoscopy} : {A} {Systematic} {Review} and {Meta}-analysis},
	volume = {176},
	issn = {1539-3704},
	shorttitle = {Real-{Time} {Computer}-{Aided} {Detection} of {Colorectal} {Neoplasia} {During} {Colonoscopy}},
	doi = {10.7326/M22-3678},
	abstract = {BACKGROUND: Artificial intelligence computer-aided detection (CADe) of colorectal neoplasia during colonoscopy may increase adenoma detection rates (ADRs) and reduce adenoma miss rates, but it may increase overdiagnosis and overtreatment of nonneoplastic polyps.
PURPOSE: To quantify the benefits and harms of CADe in randomized trials.
DESIGN: Systematic review and meta-analysis. (PROSPERO: CRD42022293181).
DATA SOURCES: Medline, Embase, and Scopus databases through February 2023.
STUDY SELECTION: Randomized trials comparing CADe-assisted with standard colonoscopy for polyp and cancer detection.
DATA EXTRACTION: Adenoma detection rate (proportion of patients with ≥1 adenoma), number of adenomas detected per colonoscopy, advanced adenoma (≥10 mm with high-grade dysplasia and villous histology), number of serrated lesions per colonoscopy, and adenoma miss rate were extracted as benefit outcomes. Number of polypectomies for nonneoplastic lesions and withdrawal time were extracted as harm outcomes. For each outcome, studies were pooled using a random-effects model. Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework.
DATA SYNTHESIS: Twenty-one randomized trials on 18 232 patients were included. The ADR was higher in the CADe group than in the standard colonoscopy group (44.0\% vs. 35.9\%; relative risk, 1.24 [95\% CI, 1.16 to 1.33]; low-certainty evidence), corresponding to a 55\% (risk ratio, 0.45 [CI, 0.35 to 0.58]) relative reduction in miss rate (moderate-certainty evidence). More nonneoplastic polyps were removed in the CADe than the standard group (0.52 vs. 0.34 per colonoscopy; mean difference [MD], 0.18 polypectomy [CI, 0.11 to 0.26 polypectomy]; low-certainty evidence). Mean inspection time increased only marginally with CADe (MD, 0.47 minute [CI, 0.23 to 0.72 minute]; moderate-certainty evidence).
LIMITATIONS: This review focused on surrogates of patient-important outcomes. Most patients, however, may consider cancer incidence and cancer-related mortality important outcomes. The effect of CADe on such patient-important outcomes remains unclear.
CONCLUSION: The use of CADe for polyp detection during colonoscopy results in increased detection of adenomas but not advanced adenomas and in higher rates of unnecessary removal of nonneoplastic polyps.
PRIMARY FUNDING SOURCE: European Commission Horizon 2020 Marie Skłodowska-Curie Individual Fellowship.},
	language = {eng},
	number = {9},
	journal = {Annals of Internal Medicine},
	author = {Hassan, Cesare and Spadaccini, Marco and Mori, Yuichi and Foroutan, Farid and Facciorusso, Antonio and Gkolfakis, Paraskevas and Tziatzios, Georgios and Triantafyllou, Konstantinos and Antonelli, Giulio and Khalaf, Kareem and Rizkala, Tommy and Vandvik, Per Olav and Fugazza, Alessandro and Rondonotti, Emanuele and Glissen-Brown, Jeremy R. and Kamba, Shunsuke and Maida, Marcello and Correale, Loredana and Bhandari, Pradeep and Jover, Rodrigo and Sharma, Prateek and Rex, Douglas K. and Repici, Alessandro},
	month = sep,
	year = {2023},
	pmid = {37639719},
	pages = {1209--1220},
}

@article{zhao_magnitude_2019,
	title = {Magnitude, {Risk} {Factors}, and {Factors} {Associated} {With} {Adenoma} {Miss} {Rate} of {Tandem} {Colonoscopy}: {A} {Systematic} {Review} and {Meta}-analysis},
	volume = {156},
	issn = {0016-5085},
	shorttitle = {Magnitude, {Risk} {Factors}, and {Factors} {Associated} {With} {Adenoma} {Miss} {Rate} of {Tandem} {Colonoscopy}},
	doi = {10.1053/j.gastro.2019.01.260},
	abstract = {Background \& Aims
We performed a systematic review and meta-analysis to comprehensively estimate adenoma miss rate (AMR) and advanced AMR (AAMR) and explore associated factors.
Methods
We searched the PubMed, Web of Science, and Ovid EMBASE databases for studies published through April 2018 on tandem colonoscopies, with AMR and AAMR as the primary outcomes. We performed meta-regression analyses to identify risk factors and factors associated with outcome. Primary outcomes were AMR and AAMR and secondary outcomes were AMR and AAMR for different locations, sizes, pathologies, morphologies, and populations.
Results
In a meta-analysis of 43 publications and more than 15,000 tandem colonoscopies, we calculated miss rates of 26\% for adenomas (95\% confidence interval [CI] 23\%–30\%), 9\% for advanced adenomas (95\% CI 4\%–16\%), and 27\% for serrated polyps (95\% CI 16\%–40\%). Miss rates were high for proximal advanced adenomas (14\%; 95\% CI 5\%–26\%), serrated polyps (27\%; 95\% CI 16\%–40\%), flat adenomas (34\%; 95\% CI 24\%–45\%), and in patients at high risk for colorectal cancer (33\%; 95\% CI 26\%–41\%). Miss rates could be decreased by adequate bowel preparation and auxiliary techniques (P = .06; P = .04, and P = .01, respectively). The adenoma detection rate (ADR), adenomas per index colonoscopy, and adenomas per positive index colonoscopy (APPC) were independently associated with AMR (P = .02, P = .01, and P = .008, respectively), whereas APPC was the only factor independently associated with AAMR (P = .006). An APPC value greater than 1.8 was more effective in monitoring AMR (31\% vs 15\% for AMR P {\textless} .0001) than an ADR value of at least 34\% (27\% vs 17\% for AMR; P = .008). The AAMR of colonoscopies with an APPC value below 1.7 was 35\%, vs 2\% for colonoscopies with an APPC value of at least 1.7 (P = .0005).
Conclusions
In a systematic review and meta-analysis, we found that adenomas and advanced adenomas are missed (based on AMR and AAMR) more frequently than previously believed. In addition to ADR, APPC deserves consideration as a complementary indicator of colonoscopy quality, if it is validated in additional studies.},
	language = {en},
	number = {6},
	journal = {Gastroenterology},
	author = {Zhao, Shengbing and Wang, Shuling and Pan, Peng and Xia, Tian and Chang, Xin and Yang, Xia and Guo, Liliangzi and Meng, Qianqian and Yang, Fan and Qian, Wei and Xu, Zhichao and Wang, Yuanqiong and Wang, Zhijie and Gu, Lun and Wang, Rundong and Jia, Fangzhou and Yao, Jun and Li, Zhaoshen and Bai, Yu},
	month = may,
	year = {2019},
	pages = {1661--1674.e11},
}

@article{yao_effect_2022,
	title = {Effect of an artificial intelligence-based quality improvement system on efficacy of a computer-aided detection system in colonoscopy: a four-group parallel study},
	volume = {54},
	issn = {0013-726X, 1438-8812},
	shorttitle = {Effect of an artificial intelligence-based quality improvement system on efficacy of a computer-aided detection system in colonoscopy},
	doi = {10.1055/a-1706-6174},
	abstract = {Background Tandem colonoscopy studies have found that about one in five adenomas are missed at colonoscopy. It remains debatable whether the combination of a computer-aided polyp detection (CADe) system with a computeraided quality improvement (CAQ) system for real-time monitoring of withdrawal speed results in additional benefits in adenoma detection or if the synergetic effect may be harmed due to excessive visual burden resulting from information overload. This study aimed to evaluate the interaction effect on improving the adenoma detection rate (ADR).},
	language = {en},
	number = {08},
	journal = {Endoscopy},
	author = {Yao, Liwen and Zhang, Lihui and Liu, Jun and Zhou, Wei and He, Chunping and Zhang, Jun and Wu, Lianlian and Wang, Hongguang and Xu, Youming and Gong, Dexin and Xu, Ming and Li, Xun and Bai, Yutong and Gong, Rongrong and Sharma, Prateek and Yu, Honggang},
	month = aug,
	year = {2022},
	pages = {757--768},
}

@article{aniwan_computer-aided_2023,
	title = {Computer-aided detection, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: a randomized controlled trial},
	volume = {97},
	issn = {0016-5107},
	shorttitle = {Computer-aided detection, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection},
	doi = {10.1016/j.gie.2022.09.023},
	abstract = {Background and Aims
Computer-aided detection (CADe) and a mucosal exposure device can improve adenoma detection rate (ADR). Potential benefits of combining the 2 modalities have never been studied. This study aimed to compare ADR differences among CADe alone, endocuff-assisted colonoscopy (EAC) alone, and the combination of CADe and EAC (CADe+EAC) with standard colonoscopy.
Methods
This prospective randomized controlled study included 1245 participants who underwent screening colonoscopy. Participants were randomized to CADe, EAC, CADe+EAC, and standard colonoscopy as a control. The primary outcome was ADR. Secondary outcomes were proximal ADR (pADR), advanced ADR (AADR), and the number of adenomas per colonoscopy (APCs).
Results
ADRs from the control, CADe, EAC, and CADe+EAC groups were 41.9\%, 52.2\%, 54.0\%, and 58.8\%, respectively; pADRs were 25.2\%, 33.3\%, 34.9\%, and 37.0\%, respectively; AADRs were 7.7\%, 8.3\%, 8.3\%, and 13.6\%, respectively; and APCs were .76, 1.11, 1.18, and 1.31, respectively. Significant increases in ADR and pADR were observed between the intervention and control groups (P {\textless} .05 in all comparisons). The AADR was significantly higher only in the CADe+EAC group than in the control group (P = .02). The adjusted incidence rate ratios of APCs were significantly higher in the intervention groups versus the control group (P {\textless} .01 in all comparisons).
Conclusions
CADe+EAC significantly improve ADR and AADR over standard colonoscopy. However, although CADe or EAC alone can substantially increase the detection of adenomas, they do not lead to increased detection of advanced adenomas unless used in combination. (Clinical trial registration number: TCTR20200929003.)},
	number = {3},
	journal = {Gastrointestinal Endoscopy},
	author = {Aniwan, Satimai and Mekritthikrai, Krittaya and Kerr, Stephen J. and Tiankanon, Kasenee and Vandaungden, Kunvadee and Sritunyarat, Yingluk and Piyachaturawat, Panida and Luangsukrerk, Thanawat and Kulpatcharapong, Santi and Wisedopas, Naruemon and Kongtub, Natanong and Kullavanijaya, Pinit and Rerknimitr, Rungsun},
	month = mar,
	year = {2023},
	pages = {507--516},
}

@article{xu_artificial_2023,
	title = {Artificial {Intelligence}–{Assisted} {Colonoscopy} for {Colorectal} {Cancer} {Screening}: {A} {Multicenter} {Randomized} {Controlled} {Trial}},
	volume = {21},
	issn = {1542-3565},
	shorttitle = {Artificial {Intelligence}–{Assisted} {Colonoscopy} for {Colorectal} {Cancer} {Screening}},
	doi = {10.1016/j.cgh.2022.07.006},
	abstract = {Background and Aims
Artificial intelligence (AI)–assisted colonoscopy improves polyp detection and characterization in colonoscopy. However, data from large-scale multicenter randomized controlled trials (RCT) in an asymptomatic population are lacking.
Methods
This multicenter RCT aimed to compare AI-assisted colonoscopy with conventional colonoscopy for adenoma detection in an asymptomatic population. Asymptomatic subjects 45–75 years of age undergoing colorectal cancer screening by direct colonoscopy or fecal immunochemical test were recruited in 6 referral centers in Hong Kong, Jilin, Inner Mongolia, Xiamen, and Beijing. In the AI-assisted colonoscopy, an AI polyp detection system (Eagle-Eye) with real-time notification on the same monitor of the endoscopy system was used. The primary outcome was overall adenoma detection rate (ADR). Secondary outcomes were mean number of adenomas per colonoscopy, ADR according to endoscopist’s experience, and colonoscopy withdrawal time. This study received Institutional Review Board approval (CRE-2019.393).
Results
From November 2019 to August 2021, 3059 subjects were randomized to AI-assisted colonoscopy (n = 1519) and conventional colonoscopy (n = 1540). Baseline characteristics and bowel preparation quality between the 2 groups were similar. The overall ADR (39.9\% vs 32.4\%; P {\textless} .001), advanced ADR (6.6\% vs 4.9\%; P = .041), ADR of expert (42.3\% vs 32.8\%; P {\textless} .001) and nonexpert endoscopists (37.5\% vs 32.1\%; P = .023), and adenomas per colonoscopy (0.59 ± 0.97 vs 0.45 ± 0.81; P {\textless} .001) were all significantly higher in the AI-assisted colonoscopy. The median withdrawal time (8.3 minutes vs 7.8 minutes; P = .004) was slightly longer in the AI-assisted colonoscopy group.
Conclusions
In this multicenter RCT in asymptomatic patients, AI-assisted colonoscopy improved overall ADR, advanced ADR, and ADR of both expert and nonexpert attending endoscopists. (ClinicalTrials.gov, Number: NCT04422548).},
	number = {2},
	journal = {Clinical Gastroenterology and Hepatology},
	author = {Xu, Hong and Tang, Raymond S. Y. and Lam, Thomas Y. T. and Zhao, Guijun and Lau, James Y. W. and Liu, Yunpeng and Wu, Qi and Rong, Long and Xu, Weiran and Li, Xue and Wong, Sunny H. and Cai, Shuntian and Wang, Jing and Liu, Guanyi and Ma, Tantan and Liang, Xiong and Mak, Joyce W. Y. and Xu, Hongzhi and Yuan, Peng and Cao, Tingting and Li, Fudong and Ye, Zhenshi and Shutian, Zhang and Sung, Joseph J. Y.},
	month = feb,
	year = {2023},
	pages = {337--346.e3},
}

@article{levy_artificial_2022,
	title = {Artificial {Intelligence}-{Aided} {Colonoscopy} {Does} {Not} {Increase} {Adenoma} {Detection} {Rate} in {Routine} {Clinical} {Practice}},
	volume = {117},
	doi = {10.14309/ajg.0000000000001970},
	abstract = {The performance of artificial intelligence-aided colonoscopy (AIAC) in a real-world setting has not been described. We compared adenoma and polyp detection rates (ADR/PDR) in a 6-month period before (pre-AIAC) and after introduction of AIAC (GI Genius, Medtronic) in all endoscopy suites
in our large-volume center. The ADR and PDR in the AIAC group was lower compared with those in the pre-AIAC group (30.3\% vs 35.2\%, P {\textless} 0.001; 36.5\% vs 40.9\%, P = 0.004, respectively); procedure time was significantly shorter in the AIAC group. In summary, introduction of AIAC
did not result in performance improvement in our large-center cohort, raising important questions on AI-human interactions in medicine.},
	number = {11},
	journal = {The American Journal of Gastroenterology},
	author = {Levy, Idan and Bruckmayer, Liora and Klang, Eyal and Ben-Horin, Shomron and Kopylov, Uri},
	month = nov,
	year = {2022},
	pages = {1871--1873},
}

@article{ladabaum_computer-aided_2023,
	title = {Computer-aided {Detection} of {Polyps} {Does} {Not} {Improve} {Colonoscopist} {Performance} in a {Pragmatic} {Implementation} {Trial}},
	volume = {164},
	issn = {1528-0012},
	doi = {10.1053/j.gastro.2022.12.004},
	language = {eng},
	number = {3},
	journal = {Gastroenterology},
	author = {Ladabaum, Uri and Shepard, John and Weng, Yingjie and Desai, Manisha and Singer, Sara J. and Mannalithara, Ajitha},
	month = mar,
	year = {2023},
	pmid = {36528131},
	pages = {481--483.e6},
}

@article{ahmad_evaluation_2023,
	title = {Evaluation of a real-time computer-aided polyp detection system during screening colonoscopy: {AI}-{DETECT} study},
	volume = {55},
	issn = {1438-8812},
	shorttitle = {Evaluation of a real-time computer-aided polyp detection system during screening colonoscopy},
	doi = {10.1055/a-1966-0661},
	abstract = {BACKGROUND: Polyp detection and resection during colonoscopy significantly reduce long-term colorectal cancer risk. Computer-aided detection (CADe) may increase polyp identification but has undergone limited clinical evaluation. Our aim was to assess the effectiveness of CADe at colonoscopy within a bowel cancer screening program (BCSP).
METHODS: This prospective, randomized controlled trial involved all eight screening-accredited colonoscopists at an English National Health Service (NHS) BCSP center (February 2020 to December 2021). Patients were randomized to CADe or standard colonoscopy. Patients meeting NHS criteria for bowel cancer screening were included. The primary outcome of interest was polyp detection rate (PDR).
RESULTS: 658 patients were invited and 44 were excluded. A total of 614 patients were randomized to CADe (n = 308) or standard colonoscopy (n = 306); 35 cases were excluded from the per-protocol analysis due to poor bowel preparation (n = 10), an incomplete procedure (n = 24), or a data issue (n = 1). Endocuff Vision was frequently used and evenly distributed (71.7 \% CADe and 69.2 \% standard). On intention-to-treat (ITT) analysis, there was a borderline significant difference in PDR (85.7 \% vs. 79.7 \%; P = 0.05) but no significant difference in adenoma detection rate (ADR; 71.4 \% vs. 65.0 \%; P = 0.09) for CADe vs. standard groups, respectively. On per-protocol analysis, no significant difference was observed in these rates. There was no significant difference in procedure times.
CONCLUSIONS: In high-performing colonoscopists in a BCSP who routinely used Endocuff Vision, CADe improved PDR but not ADR. CADe appeared to have limited benefit in a BCSP setting where procedures are performed by experienced colonoscopists.},
	language = {eng},
	number = {4},
	journal = {Endoscopy},
	author = {Ahmad, Ahmir and Wilson, Ana and Haycock, Adam and Humphries, Adam and Monahan, Kevin and Suzuki, Noriko and Thomas-Gibson, Siwan and Vance, Margaret and Bassett, Paul and Thiruvilangam, Kowshika and Dhillon, Angad and Saunders, Brian P.},
	month = apr,
	year = {2023},
	pmid = {36509103},
	pages = {313--319},
}

@article{wei_evaluation_2022,
	title = {Evaluation of {Computer}-{Aided} {Detection} {During} {Colonoscopy} in the {Community} ({AI}-{SEE}): {A} {Multicenter} {Randomized} {Clinical} {Trial}},
	issn = {0002-9270},
	shorttitle = {Evaluation of {Computer}-{Aided} {Detection} {During} {Colonoscopy} in the {Community} ({AI}-{SEE})},
	doi = {10.14309/ajg.0000000000002239},
	abstract = {INTRODUCTION: 
          There has been increasing interest in artificial intelligence in gastroenterology. To reduce miss rates during colonoscopy, there has been significant exploration in computer-aided detection (CADe) devices. In this study, we evaluate the use of CADe in colonoscopy in community-based, nonacademic practices.
          METHODS: 
          Between September 28, 2020, and September 24, 2021, a randomized controlled trial (AI-SEE) was performed evaluating the impact of CADe on polyp detection in 4 community-based endoscopy centers in the United States Patients were block-randomized to undergoing colonoscopy with or without CADe (EndoVigilant). Primary outcomes measured were adenomas per colonoscopy and adenomas per extraction (the percentage of polyps removed that are adenomas). Secondary end points included serrated polyps per colonoscopy; nonadenomatous, nonserrated polyps per colonoscopy; adenoma and serrated polyp detection rates; and procedural time.
          RESULTS: 
          A total of 769 patients were enrolled (387 with CADe), with similar patient demographics between the 2 groups. There was no significant difference in adenomas per colonoscopy in the CADe and non-CADe groups (0.73 vs 0.67, P = 0.496). Although the use of CADe did not improve identification of serrated polyps per colonoscopy (0.08 vs 0.08, P = 0.965), the use of CADe increased identification of nonadenomatous, nonserrated polyps per colonoscopy (0.90 vs 0.51, P {\textless} 0.0001), resulting in detection of fewer adenomas per extraction in the CADe group. The adenoma detection rate (35.9 vs 37.2\%, P = 0.774) and serrated polyp detection rate (6.5 vs 6.3\%, P = 1.000) were similar in the CADe and non-CADe groups. Mean withdrawal time was longer in the CADe group compared with the non-CADe group (11.7 vs 10.7 minutes, P = 0.003). However, when no polyps were identified, there was similar mean withdrawal time (9.1 vs 8.8 minutes, P = 0.288). There were no adverse events.
          DISCUSSION: 
          The use of CADe did not result in a statistically significant difference in the number of adenomas detected. Additional studies are needed to better understand why some endoscopists derive substantial benefits from CADe and others do not. ClinicalTrials.gov number: NCT04555135.},
	language = {en-US},
	journal = {Official journal of the American College of Gastroenterology {\textbar} ACG},
	author = {Wei, Mike T. and Shankar, Uday and Parvin, Russell and Abbas, Syed Hasan and Chaudhary, Sushant and Friedlander, Yishai and Friedland, Shai},
	month = may,
	year = {2022},
	pages = {10.14309/ajg.0000000000002239},
}

@article{wei_artificial_2024,
	title = {Artificial {Intelligence}-{Assisted} {Colonoscopy} in {Real}-{World} {Clinical} {Practice}: {A} {Systematic} {Review} and {Meta}-{Analysis}},
	volume = {15},
	issn = {2155-384X},
	shorttitle = {Artificial {Intelligence}-{Assisted} {Colonoscopy} in {Real}-{World} {Clinical} {Practice}},
	doi = {10.14309/ctg.0000000000000671},
	abstract = {INTRODUCTION: Artificial intelligence (AI) could minimize the operator-dependent variation in colonoscopy quality. Computer-aided detection (CADe) has improved adenoma detection rate (ADR) and adenomas per colonoscopy (APC) in randomized controlled trials. There is a need to assess the impact of CADe in real-world settings.
METHODS: We searched MEDLINE, EMBASE, and Web of Science for nonrandomized real-world studies of CADe in colonoscopy. Random-effects meta-analyses were performed to examine the effect of CADe on ADR and APC. The study is registered under PROSPERO (CRD42023424037). There was no funding for this study.
RESULTS: Twelve of 1,314 studies met inclusion criteria. Overall, ADR was statistically significantly higher with vs without CADe (36.3\% vs 35.8\%, risk ratio [RR] 1.13, 95\% confidence interval [CI] 1.01-1.28). This difference remained significant in subgroup analyses evaluating 6 prospective (37.3\% vs 35.2\%, RR 1.15, 95\% CI 1.01-1.32) but not 6 retrospective (35.7\% vs 36.2\%, RR 1.12, 95\% CI 0.92-1.36) studies. Among 6 studies with APC data, APC rate ratio with vs without CADe was 1.12 (95\% CI 0.95-1.33). In 4 studies with GI Genius (Medtronic), there was no difference in ADR with vs without CADe (RR 0.96, 95\% CI 0.85-1.07).
DISCUSSION: ADR, but not APC, was slightly higher with vs without CADe among all available real-world studies. This difference was attributed to the results of prospective but not retrospective studies. The discrepancies between these findings and those of randomized controlled trials call for future research on the true impact of current AI technology on colonoscopy quality and the subtleties of human-AI interactions.},
	language = {eng},
	number = {3},
	journal = {Clinical and Translational Gastroenterology},
	author = {Wei, Mike Tzuhen and Fay, Shmuel and Yung, Diana and Ladabaum, Uri and Kopylov, Uri},
	month = mar,
	year = {2024},
	pmid = {38146871},
	pmcid = {PMC10962886},
	pages = {e00671},
}

@article{troya_direct_2023,
	title = {Direct comparison of multiple computer-aided polyp detection systems},
	issn = {1438-8812},
	doi = {10.1055/a-2147-0571},
	abstract = {BACKGROUND AND STUDY AIMS: Artificial intelligence based computer-aided polyp detection (CADe) systems receive regular updates and occasionally offer customizable detection thresholds which impact their performance, but little is known about these effects. This study aimed to compare the performance of different CADe systems on the same benchmark dataset.
METHODS: 101 colonoscopy videos were used as benchmark. Each video frame with a visible polyp was manually annotated with bounding boxes resulting in 129,705 polyp images. The videos were then analyzed by three different CADe systems: two versions of GI-Genius, two detection types of EndoAID and the freely-available system EndoMind. The evaluation included an extensive analysis of sensitivity and false-positive rate, among others.
RESULTS: EndoAID (Type A), the earlier version of GI-Genius and EndoMind detected all 93 polyps. Both the later version of GI-Genius and EndoAID (Type B) missed one polyp. The mean per-frame sensitivity was of 50.63\% and 67.85\% for the earlier and the latest version of GI-Genius, 65.60\% and 52.95\% for EndoAID (Type A and B), and 60.22\% for EndoMind.
CONCLUSIONS: This study compares the performance of different CADe systems, different updates, and different configuration modes. This might help clinicians to select the most appropriate system for their specific needs.},
	language = {eng},
	journal = {Endoscopy},
	author = {Troya, Joel and Sudarevic, Boban and Krenzer, Adrian and Banck, Michael and Brand, Markus and Walter, Benjamin M. and Puppe, Frank and Zoller, Wolfram G. and Meining, Alexander and Hann, Alexander},
	month = aug,
	year = {2023},
	pmid = {37532115},
}

@article{noauthor_german_nodate,
	title = {German {Guideline} {Program} in {Oncology} ({German} {Cancer} {Society}, {German} {Cancer} {Aid}, {AWMF}): {S3}-{Guideline} {Colorectal} {Cancer}, long version 2.1, 2019, {AWMF} registrationnumber: 021-{007OL}, http://www.leitlinienprogrammonkologie.de/leitlinien/kolorektales-karzinom/ [cited: 15/07/24]},
	language = {de},
}

@article{wang_real-time_2019,
	title = {Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates: a prospective randomised controlled study},
	volume = {68},
	issn = {1468-3288},
	shorttitle = {Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates},
	doi = {10.1136/gutjnl-2018-317500},
	abstract = {OBJECTIVE: The effect of colonoscopy on colorectal cancer mortality is limited by several factors, among them a certain miss rate, leading to limited adenoma detection rates (ADRs). We investigated the effect of an automatic polyp detection system based on deep learning on polyp detection rate and ADR.
DESIGN: In an open, non-blinded trial, consecutive patients were prospectively randomised to undergo diagnostic colonoscopy with or without assistance of a real-time automatic polyp detection system providing a simultaneous visual notice and sound alarm on polyp detection. The primary outcome was ADR.
RESULTS: Of 1058 patients included, 536 were randomised to standard colonoscopy, and 522 were randomised to colonoscopy with computer-aided diagnosis. The artificial intelligence (AI) system significantly increased ADR (29.1\%vs20.3\%, p{\textless}0.001) and the mean number of adenomas per patient (0.53vs0.31, p{\textless}0.001). This was due to a higher number of diminutive adenomas found (185vs102; p{\textless}0.001), while there was no statistical difference in larger adenomas (77vs58, p=0.075). In addition, the number of hyperplastic polyps was also significantly increased (114vs52, p{\textless}0.001).
CONCLUSIONS: In a low prevalent ADR population, an automatic polyp detection system during colonoscopy resulted in a significant increase in the number of diminutive adenomas detected, as well as an increase in the rate of hyperplastic polyps. The cost-benefit ratio of such effects has to be determined further.
TRIAL REGISTRATION NUMBER: ChiCTR-DDD-17012221; Results.},
	language = {eng},
	number = {10},
	journal = {Gut},
	author = {Wang, Pu and Berzin, Tyler M. and Glissen Brown, Jeremy Romek and Bharadwaj, Shishira and Becq, Aymeric and Xiao, Xun and Liu, Peixi and Li, Liangping and Song, Yan and Zhang, Di and Li, Yi and Xu, Guangre and Tu, Mengtian and Liu, Xiaogang},
	month = oct,
	year = {2019},
	pmid = {30814121},
	pmcid = {PMC6839720},
	pages = {1813--1819},
}

@article{repici_efficacy_2020,
	title = {Efficacy of {Real}-{Time} {Computer}-{Aided} {Detection} of {Colorectal} {Neoplasia} in a {Randomized} {Trial}},
	volume = {159},
	issn = {1528-0012},
	doi = {10.1053/j.gastro.2020.04.062},
	abstract = {BACKGROUND \& AIMS: One-fourth of colorectal neoplasias are missed during screening colonoscopies; these can develop into colorectal cancer (CRC). Deep learning systems allow for real-time computer-aided detection (CADe) of polyps with high accuracy. We performed a multicenter, randomized trial to assess the safety and efficacy of a CADe system in detection of colorectal neoplasias during real-time colonoscopy.
METHODS: We analyzed data from 685 subjects (61.32 ± 10.2 years old; 337 men) undergoing screening colonoscopies for CRC, post-polypectomy surveillance, or workup due to positive results from a fecal immunochemical test or signs or symptoms of CRC, at 3 centers in Italy from September through November 2019. Patients were randomly assigned (1:1) to groups who underwent high-definition colonoscopies with the CADe system or without (controls). The CADe system included an artificial intelligence-based medical device (GI-Genius, Medtronic) trained to process colonoscopy images and superimpose them, in real time, on the endoscopy display a green box over suspected lesions. A minimum withdrawal time of 6 minutes was required. Lesions were collected and histopathology findings were used as the reference standard. The primary outcome was adenoma detection rate (ADR, the percentage of patients with at least 1 histologically proven adenoma or carcinoma). Secondary outcomes were adenomas detected per colonoscopy, non-neoplastic resection rate, and withdrawal time.
RESULTS: The ADR was significantly higher in the CADe group (54.8\%) than in the control group (40.4\%) (relative risk [RR], 1.30; 95\% confidence interval [CI], 1.14-1.45). Adenomas detected per colonoscopy were significantly higher in the CADe group (mean, 1.07 ±1.54) than in the control group (mean 0.71 ± 1.20) (incidence rate ratio, 1.46; 95\% CI, 1.15-1.86). Adenomas 5 mm or smaller were detected in a significantly higher proportion of subjects in the CADe group (33.7\%) than in the control group (26.5\%; RR, 1.26; 95\% CI, 1.01-1.52), as were adenomas of 6 to 9 mm (detected in 10.6\% of subjects in the CADe group vs 5.8\% in the control group; RR, 1.78; 95\% CI, 1.09-2.86), regardless of morphology or location. There was no significant difference between groups in withdrawal time (417 ± 101 seconds for the CADe group vs 435 ± 149 for controls; P = .1) or proportion of subjects with resection of non-neoplastic lesions (26.0\% in the CADe group vs 28.7\% of controls; RR, 1.00; 95\% CI, 0.90-1.12).
CONCLUSIONS: In a multicenter, randomized trial, we found that including CADe in real-time colonoscopy significantly increases ADR and adenomas detected per colonoscopy without increasing withdrawal time. ClinicalTrials.gov no: 04079478.},
	language = {eng},
	number = {2},
	journal = {Gastroenterology},
	author = {Repici, Alessandro and Badalamenti, Matteo and Maselli, Roberta and Correale, Loredana and Radaelli, Franco and Rondonotti, Emanuele and Ferrara, Elisa and Spadaccini, Marco and Alkandari, Asma and Fugazza, Alessandro and Anderloni, Andrea and Galtieri, Piera Alessia and Pellegatta, Gaia and Carrara, Silvia and Di Leo, Milena and Craviotto, Vincenzo and Lamonaca, Laura and Lorenzetti, Roberto and Andrealli, Alida and Antonelli, Giulio and Wallace, Michael and Sharma, Prateek and Rosch, Thomas and Hassan, Cesare},
	month = aug,
	year = {2020},
	pmid = {32371116},
	pages = {512--520.e7},
}

@article{liu_study_2020,
	title = {Study on detection rate of polyps and adenomas in artificial-intelligence-aided colonoscopy},
	volume = {26},
	issn = {1998-4049},
	doi = {10.4103/sjg.SJG_377_19},
	abstract = {Background/Aim: To study the impact of computer-aided detection (CADe) system on the detection rate of polyps and adenomas in colonoscopy.
Materials and Methods: A total of 1026 patients were prospectively randomly scheduled for colonoscopy with (the CADe group, CADe) or without (the control group, CON) the aid of the CADe system, together with visual notification and voice alarm, so as to compare the detection rate of polyp.
Results: Compared with group CON, the detection rate of adenomas increased in group CADe, the average number of adenomas increased, the number of small adenomas increased, the number of proliferative polyps increased, and the differences were statistically significant (P {\textless} 0.001), but the comparison for the number of larger adenomas showed no significant difference between the groups (P{\textgreater} 0.05).
Conclusions: The CADe system is feasible for increasing the detection of polyps and adenomas in colonoscopy.},
	language = {eng},
	number = {1},
	journal = {Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association},
	author = {Liu, Wen-Na and Zhang, Yang-Yang and Bian, Xu-Qiang and Wang, Li-Juan and Yang, Qiang and Zhang, Xi-Dou and Huang, Jin},
	month = feb,
	year = {2020},
	pmid = {31898644},
	pmcid = {PMC7045775},
	pages = {13--19},
}

@article{repici_artificial_2022,
	title = {Artificial intelligence and colonoscopy experience: lessons from two randomised trials},
	volume = {71},
	issn = {0017-5749, 1468-3288},
	shorttitle = {Artificial intelligence and colonoscopy experience},
	doi = {10.1136/gutjnl-2021-324471},
	abstract = {Background and aims Artificial intelligence has been shown to increase adenoma detection rate (ADR) as the main surrogate outcome parameter of colonoscopy quality. To which extent this effect may be related to physician experience is not known. We performed a randomised trial with colonoscopists in their qualification period (AID-2) and compared these data with a previously published randomised trial in expert endoscopists (AID-1).
Methods In this prospective, randomised controlled non-inferiority trial (AID-2), 10 non-expert endoscopists ({\textless}2000 colonoscopies) performed screening/surveillance/diagnostic colonoscopies in consecutive 40–80 year-old subjects using high-definition colonoscopy with or without a real-time deep-learning computer-aided detection (CADe) (GI Genius, Medtronic). The primary outcome was ADR in both groups with histology of resected lesions as reference. In a post-hoc analysis, data from this randomised controlled trial (RCT) were compared with data from the previous AID-1 RCT involving six experienced endoscopists in an otherwise similar setting.
Results In 660 patients (62.3±10 years; men/women: 330/330) with equal distribution of study parameters, overall ADR was higher in the CADe than in the control group (53.3\% vs 44.5\%; relative risk (RR): 1.22; 95\% CI: 1.04 to 1.40; p{\textless}0.01 for non-inferiority and p=0.02 for superiority). Similar increases were seen in adenoma numbers per colonoscopy and in small and distal lesions. No differences were observed with regards to detection of non-neoplastic lesions. When pooling these data with those from the AID-1 study, use of CADe (RR 1.29; 95\% CI: 1.16 to 1.42) and colonoscopy indication, but not the level of examiner experience (RR 1.02; 95\% CI: 0.89 to 1.16) were associated with ADR differences in a multivariate analysis.
Conclusions In less experienced examiners, CADe assistance during colonoscopy increased ADR and a number of related polyp parameters as compared with the control group. Experience appears to play a minor role as determining factor for ADR.
Trial registration number NCT:04260321.},
	language = {en},
	number = {4},
	journal = {Gut},
	author = {Repici, Alessandro and Spadaccini, Marco and Antonelli, Giulio and Correale, Loredana and Maselli, Roberta and Galtieri, Piera Alessia and Pellegatta, Gaia and Capogreco, Antonio and Milluzzo, Sebastian Manuel and Lollo, Gianluca and Paolo, Dhanai Di and Badalamenti, Matteo and Ferrara, Elisa and Fugazza, Alessandro and Carrara, Silvia and Anderloni, Andrea and Rondonotti, Emanuele and Amato, Arnaldo and Gottardi, Andrea De and Spada, Cristiano and Radaelli, Franco and Savevski, Victor and Wallace, Michael B. and Sharma, Prateek and Rösch, Thomas and Hassan, Cesare},
	month = apr,
	year = {2022},
	pmid = {34187845},
	note = {publisher: BMJ Publishing Group
section: Artificial intelligence},
	pages = {757--765},
}

@article{su_impact_2020,
	title = {Impact of a real-time automatic quality control system on colorectal polyp and adenoma detection: a prospective randomized controlled study (with videos)},
	volume = {91},
	issn = {0016-5107},
	shorttitle = {Impact of a real-time automatic quality control system on colorectal polyp and adenoma detection},
	doi = {10.1016/j.gie.2019.08.026},
	abstract = {Background and Aims
Quality control can decrease variations in the performance of colonoscopists and improve the effectiveness of colonoscopy to prevent colorectal cancers. Unfortunately, routine quality control is difficult to carry out because a practical method is lacking. The aim of this study was to develop an automatic quality control system (AQCS) and assess whether it could improve polyp and adenoma detection in clinical practice.
Methods
First, we developed AQCS based on deep convolutional neural network models for timing of the withdrawal phase, supervising withdrawal stability, evaluating bowel preparation, and detecting colorectal polyps. Next, consecutive patients were prospectively randomized to undergo routine colonoscopies with or without the assistance of AQCS. The primary outcome of the study was the adenoma detection rate (ADR) in the AQCS and control groups.
Results
A total of 659 patients were enrolled and randomized. A total of 308 and 315 patients were analyzed in the AQCS and control groups, respectively. AQCS significantly increased the ADR (0.289 vs 0.165, P {\textless} .001) and the mean number of adenomas per procedure (0.367 vs 0.178, P {\textless} .001) compared with the control group. A significant increase was also observed in the polyp detection rate (0.383 vs 0.254, P = .001) and the mean number of polyps detected per procedure (0.575 vs 0.305, P {\textless} .001). In addition, the withdrawal time (7.03 minutes vs 5.68 minutes, P {\textless} .001) and adequate bowel preparation rate (87.34\% vs 80.63\%, P = .023) were superior for the AQCS group.
Conclusions
AQCS could effectively improve the performance of colonoscopists during the withdrawal phase and significantly increase polyp and adenoma detection. (Clinical trial registration number: NCT03622281.)},
	language = {en},
	number = {2},
	journal = {Gastrointestinal Endoscopy},
	author = {Su, Jing-Ran and Li, Zhen and Shao, Xue-Jun and Ji, Chao-Ran and Ji, Rui and Zhou, Ru-Chen and Li, Guang-Chao and Liu, Guan-Qun and He, Yi-Shan and Zuo, Xiu-Li and Li, Yan-Qing},
	month = feb,
	year = {2020},
	pages = {415--424.e4},
}

@article{gimeno-garcia_usefulness_2023,
	title = {Usefulness of a novel computer-aided detection system for colorectal neoplasia: a randomized controlled trial},
	volume = {97},
	issn = {1097-6779},
	shorttitle = {Usefulness of a novel computer-aided detection system for colorectal neoplasia},
	doi = {10.1016/j.gie.2022.09.029},
	abstract = {BACKGROUND AND AIMS: Artificial intelligence-based computer-aid detection (CADe) devices have been recently tested in colonoscopies, increasing the adenoma detection rate (ADR), mainly in Asian populations. However, evidence for the benefit of these devices in the occidental population is still low. We tested a new CADe device, namely, ENDO-AID (OIP-1) (Olympus, Tokyo, Japan), in clinical practice.
METHODS: This randomized controlled trial included 370 consecutive patients who were randomized 1:1 to CADe (n = 185) versus standard exploration (n = 185) from November 2021 to January 2022. The primary endpoint was the ADR. Advanced adenoma was defined as ≥10 mm, harboring high-grade dysplasia, or with a villous pattern. Otherwise, the adenoma was nonadvanced. ADR was assessed in both groups stratified by endoscopist ADR and colon cleansing.
RESULTS: In the intention-to-treat analysis, the ADR was 55.1\% (102/185) in the CADe group and 43.8\% (81/185) in the control group (P = .029). Nonadvanced ADRs (54.8\% vs 40.8\%, P = .01) and flat ADRs (39.4 vs 24.8, P = .006), polyp detection rate (67.1\% vs 51\%; P = .004), and number of adenomas per colonoscopy were significantly higher in the CADe group than in the control group (median [25th-75th percentile], 1 [0-2] vs 0 [0-1.5], respectively; P = .014). No significant differences were found in serrated ADR. After stratification by endoscopist and bowel cleansing, no statistically significant differences in ADR were found.
CONCLUSIONS: Colonoscopy assisted by ENDO-AID (OIP-1) increases ADR and number of adenomas per colonoscopy, suggesting it may aid in the detection of colorectal neoplastic lesions, especially because of its detection of diminutive and flat adenomas. (Clinical trial registration number: NCT04945044.).},
	language = {eng},
	number = {3},
	journal = {Gastrointestinal Endoscopy},
	author = {Gimeno-García, Antonio Z. and Hernández Negrin, Domingo and Hernández, Anjara and Nicolás-Pérez, David and Rodríguez, Eduardo and Montesdeoca, Carlota and Alarcon, Onofre and Romero, Rafael and Baute Dorta, José Luis and Cedrés, Yaiza and Castillo, Rocío Del and Jiménez, Alejandro and Felipe, Vanessa and Morales, Dalia and Ortega, Juan and Reygosa, Cristina and Quintero, Enrique and Hernández-Guerra, Manuel},
	month = mar,
	year = {2023},
	pmid = {36228695},
	pages = {528--536.e1},
}

@article{xu_artificial_2021,
	title = {Artificial intelligence-assisted colonoscopy: {A} prospective, multicenter, randomized controlled trial of polyp detection},
	volume = {10},
	issn = {2045-7634},
	shorttitle = {Artificial intelligence-assisted colonoscopy},
	doi = {10.1002/cam4.4261},
	abstract = {BACKGROUND: Artificial intelligence (AI) assistance has been considered as a promising way to improve colonoscopic polyp detection, but there are limited prospective studies on real-time use of AI systems.
METHODS: We conducted a prospective, multicenter, randomized controlled trial of patients undergoing colonoscopy at six centers. Eligible patients were randomly assigned to conventional colonoscopy (control group) or AI-assisted colonoscopy (AI group). AI assistance was our newly developed AI system for real-time colonoscopic polyp detection. Primary outcome is polyp detection rate (PDR). Secondary outcomes include polyps per positive patient (PPP), polyps per colonoscopy (PPC), and non-first polyps per colonoscopy (PPC-Plus).
RESULTS: A total of 2352 patients were included in the final analysis. Compared with the control, AI group did not show significant increment in PDR (38.8\% vs. 36.2\%, p = 0.183), but its PPC-Plus was significantly higher (0.5 vs. 0.4, p {\textless} 0.05). In addition, AI group detected more diminutive polyps (76.0\% vs. 68.8\%, p {\textless} 0.01) and flat polyps (5.9\% vs. 3.3\%, p {\textless} 0.05). The effects varied somewhat between centers. In further logistic regression analysis, AI assistance independently contributed to the increment of PDR, and the impact was more pronounced for male endoscopists, shorter insertion time but longer withdrawal time, and elderly patients with larger waist circumference.
CONCLUSION: The intervention of AI plays a limited role in overall polyp detection, but increases detection of easily missed polyps; ChiCTR.org.cn number, ChiCTR1800015607.},
	language = {eng},
	number = {20},
	journal = {Cancer Medicine},
	author = {Xu, Lei and He, Xinjue and Zhou, Jianbo and Zhang, Jie and Mao, Xinli and Ye, Guoliang and Chen, Qiang and Xu, Feng and Sang, Jianzhong and Wang, Jun and Ding, Yong and Li, Youming and Yu, Chaohui},
	month = oct,
	year = {2021},
	pmid = {34477306},
	pmcid = {PMC8525182},
	pages = {7184--7193},
}

@article{gong_detection_2020,
	title = {Detection of colorectal adenomas with a real-time computer-aided system ({ENDOANGEL}): a randomised controlled study},
	volume = {5},
	issn = {2468-1253},
	shorttitle = {Detection of colorectal adenomas with a real-time computer-aided system ({ENDOANGEL})},
	doi = {10.1016/S2468-1253(19)30413-3},
	abstract = {Background
Colonoscopy performance varies among endoscopists, impairing the discovery of colorectal cancers and precursor lesions. We aimed to construct a real-time quality improvement system (ENDOANGEL) to monitor real-time withdrawal speed and colonoscopy withdrawal time and to remind endoscopists of blind spots caused by endoscope slipping. We also aimed to evaluate the effectiveness of this system for improving adenoma yield of everyday colonoscopy.
Methods
The ENDOANGEL system was developed using deep neural networks and perceptual hash algorithms. We recruited consecutive patients aged 18–75 years from Renmin Hospital of Wuhan University in China who provided written informed consent. We randomly assigned patients (1:1) using computer-generated random numbers and block randomisation (block size of four) to either colonoscopy with the ENDOANGEL system or unassisted colonoscopy (control). Endoscopists were not masked to the random assignment but analysts and patients were unaware of random assignments. The primary endpoint was the adenoma detection rate (ADR), which is the proportion of patients having one or more adenomas detected at colonoscopy. The primary analysis was done per protocol (ie, in all patients having colonoscopy done in accordance with the assigned intervention) and by intention to treat (ie, in all randomised patients). This trial is registered with http://www.chictr.org.cn, ChiCTR1900021984.
Findings
Between June 18, 2019, and Sept 6, 2019, 704 patients were randomly allocated colonoscopy with the ENDOANGEL system (n=355) or unassisted (control) colonoscopy (n=349). In the intention-to-treat population, ADR was significantly greater in the ENDOANGEL group than in the control group, with 58 (16\%) of 355 patients allocated ENDOANGEL-assisted colonoscopy having one or more adenomas detected, compared with 27 (8\%) of 349 allocated control colonoscopy (odds ratio [OR] 2·30, 95\% CI 1·40–3·77; p=0·0010). In the per-protocol analysis, findings were similar, with 54 (17\%) of 324 patients assigned ENDOANGEL-assisted colonoscopy and 26 (8\%) of 318 patients assigned control colonoscopy having one or more adenomas detected (OR 2·18, 95\% CI 1·31–3·62; p=0·0026). No adverse events were reported.
Interpretation
The ENDOANGEL system significantly improved the adenoma yield during colonoscopy and seems to be effective and safe for use during routine colonoscopy.
Funding
Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Hubei Province Major Science and Technology Innovation Project, and the National Natural Science Foundation of China.},
	language = {en},
	number = {4},
	journal = {The Lancet Gastroenterology \& Hepatology},
	author = {Gong, Dexin and Wu, Lianlian and Zhang, Jun and Mu, Ganggang and Shen, Lei and Liu, Jun and Wang, Zhengqiang and Zhou, Wei and An, Ping and Huang, Xu and Jiang, Xiaoda and Li, Yanxia and Wan, Xinyue and Hu, Shan and Chen, Yiyun and Hu, Xiao and Xu, Youming and Zhu, Xiaoyun and Li, Suqin and Yao, Liwen and He, Xinqi and Chen, Di and Huang, Li and Wei, Xiao and Wang, Xuemei and Yu, Honggang},
	month = apr,
	year = {2020},
	pages = {352--361},
}

@article{shaukat_computer-aided_2022,
	title = {Computer-{Aided} {Detection} {Improves} {Adenomas} per {Colonoscopy} for {Screening} and {Surveillance} {Colonoscopy}: {A} {Randomized} {Trial}},
	volume = {163},
	issn = {1528-0012},
	shorttitle = {Computer-{Aided} {Detection} {Improves} {Adenomas} per {Colonoscopy} for {Screening} and {Surveillance} {Colonoscopy}},
	doi = {10.1053/j.gastro.2022.05.028},
	abstract = {BACKGROUND \& AIMS: Colonoscopy for colorectal cancer screening is endoscopist dependent, and colonoscopy quality improvement programs aim to improve efficacy. This study evaluated the clinical benefit and safety of using a computer-aided detection (CADe) device in colonoscopy procedures.
METHODS: This randomized study prospectively evaluated the use of a CADe device at 5 academic and community centers by US board-certified gastroenterologists (n = 22). Participants aged ≥40 scheduled for screening or surveillance (≥3 years) colonoscopy were included; exclusion criteria included incomplete procedure, diagnostic indication, inflammatory bowel disease, and familial adenomatous polyposis. Patients were randomized by endoscopist to the standard or CADe colonoscopy arm using computer-generated, random-block method. The 2 primary endpoints were adenomas per colonoscopy (APC), the total number of adenomas resected divided by the total number of colonoscopies; and true histology rate (THR), the proportion of resections with clinically significant histology divided by the total number of polyp resections. The primary analysis used a modified intention-to-treat approach.
RESULTS: Between January and September 2021, 1440 participants were enrolled to be randomized. After exclusion of participants who did not meet the eligibility criteria, 677 in the standard arm and 682 in the CADe arm were included in a modified intention-to-treat analysis. APC increased significantly with use of the CADe device (standard vs CADe: 0.83 vs 1.05, P = .002; total number of adenomas, 562 vs 719). There was no decrease in THR with use of the CADe device (standard vs CADe: 71.7\% vs 67.4\%, P for noninferiority {\textless} .001; total number of non-neoplastic lesions, 284 vs 375). Adenoma detection rate was 43.9\% and 47.8\% in the standard and CADe arms, respectively (P = .065).
CONCLUSIONS: For experienced endoscopists performing screening and surveillance colonoscopies in the United States, the CADe device statistically improved overall adenoma detection (APC) without a concomitant increase in resection of non-neoplastic lesions (THR).
CLINICALTRIALS: gov registration: NCT04754347.},
	language = {eng},
	number = {3},
	journal = {Gastroenterology},
	author = {Shaukat, Aasma and Lichtenstein, David R. and Somers, Samuel C. and Chung, Daniel C. and Perdue, David G. and Gopal, Murali and Colucci, Daniel R. and Phillips, Sloane A. and Marka, Nicholas A. and Church, Timothy R. and Brugge, William R. and {SKOUT™ Registration Study Team}},
	month = sep,
	year = {2022},
	pmid = {35643173},
	pages = {732--741},
}

@article{seager_polyp_2024,
	title = {Polyp detection with colonoscopy assisted by the {GI} {Genius} artificial intelligence endoscopy module compared with standard colonoscopy in routine colonoscopy practice ({COLO}-{DETECT}): a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial},
	volume = {9},
	issn = {2468-1253},
	doi = {10.1016/S2468-1253(24)00161-4},
	number = {10},
	journal = {The Lancet Gastroenterology \& Hepatology},
	author = {Seager, Alexander and Sharp, Linda and Neilson, Laura J and Brand, Andrew and Hampton, James S and Lee, Tom J W and Evans, Rachel and Vale, Luke and Whelpton, John and Bestwick, Nathania and Rees, Colin J and Cripps, Neil and Greenaway, John and Higham, Andrew and Jacob, John and Murugananthan, Aravinth and Nylander, David and Patel, Panna and Singh, Salil and Verma, Ajay M},
	month = oct,
	year = {2024},
	note = {publisher: Elsevier},
	pages = {911--923},
}

@article{desai_use_2024,
	title = {Use of a {Novel} {Artificial} {Intelligence} {System} {Leads} to the {Detection} of {Significantly} {Higher} {Number} of {Adenomas} {During} {Screening} and {Surveillance} {Colonoscopy}: {Results} {From} a {Large}, {Prospective}, {US} {Multicenter}, {Randomized} {Clinical} {Trial}},
	volume = {119},
	issn = {1572-0241},
	shorttitle = {Use of a {Novel} {Artificial} {Intelligence} {System} {Leads} to the {Detection} of {Significantly} {Higher} {Number} of {Adenomas} {During} {Screening} and {Surveillance} {Colonoscopy}},
	doi = {10.14309/ajg.0000000000002664},
	abstract = {INTRODUCTION: Adenoma per colonoscopy (APC) has recently been proposed as a quality measure for colonoscopy. We evaluated the impact of a novel artificial intelligence (AI) system, compared with standard high-definition colonoscopy, for APC measurement.
METHODS: This was a US-based, multicenter, prospective randomized trial examining a novel AI detection system (EW10-EC02) that enables a real-time colorectal polyp detection enabled with the colonoscope (CAD-EYE). Eligible average-risk subjects (45 years or older) undergoing screening or surveillance colonoscopy were randomized to undergo either CAD-EYE-assisted colonoscopy (CAC) or conventional colonoscopy (CC). Modified intention-to-treat analysis was performed for all patients who completed colonoscopy with the primary outcome of APC. Secondary outcomes included positive predictive value (total number of adenomas divided by total polyps removed) and adenoma detection rate.
RESULTS: In modified intention-to-treat analysis, of 1,031 subjects (age: 59.1 ± 9.8 years; 49.9\% male), 510 underwent CAC vs 523 underwent CC with no significant differences in age, gender, ethnicity, or colonoscopy indication between the 2 groups. CAC led to a significantly higher APC compared with CC: 0.99 ± 1.6 vs 0.85 ± 1.5, P = 0.02, incidence rate ratio 1.17 (1.03-1.33, P = 0.02) with no significant difference in the withdrawal time: 11.28 ± 4.59 minutes vs 10.8 ± 4.81 minutes; P = 0.11 between the 2 groups. Difference in positive predictive value of a polyp being an adenoma among CAC and CC was less than 10\% threshold established: 48.6\% vs 54\%, 95\% CI -9.56\% to -1.48\%. There were no significant differences in adenoma detection rate (46.9\% vs 42.8\%), advanced adenoma (6.5\% vs 6.3\%), sessile serrated lesion detection rate (12.9\% vs 10.1\%), and polyp detection rate (63.9\% vs 59.3\%) between the 2 groups. There was a higher polyp per colonoscopy with CAC compared with CC: 1.68 ± 2.1 vs 1.33 ± 1.8 (incidence rate ratio 1.27; 1.15-1.4; P {\textless} 0.01).
DISCUSSION: Use of a novel AI detection system showed to a significantly higher number of adenomas per colonoscopy compared with conventional high-definition colonoscopy without any increase in colonoscopy withdrawal time, thus supporting the use of AI-assisted colonoscopy to improve colonoscopy quality ( ClinicalTrials.gov NCT04979962).},
	language = {eng},
	number = {7},
	journal = {The American Journal of Gastroenterology},
	author = {Desai, Madhav and Ausk, Karlee and Brannan, Donald and Chhabra, Rajiv and Chan, Walter and Chiorean, Michael and Gross, Seth A. and Girotra, Mohit and Haber, Gregory and Hogan, Reed B. and Jacob, Bobby and Jonnalagadda, Sreeni and Iles-Shih, Lulu and Kumar, Navin and Law, Joanna and Lee, Linda and Lin, Otto and Mizrahi, Meir and Pacheco, Paulo and Parasa, Sravanthi and Phan, Jennifer and Reeves, Vonda and Sethi, Amrita and Snell, David and Underwood, James and Venu, Nanda and Visrodia, Kavel and Wong, Alina and Winn, Jessica and Wright, Cindy Haden and Sharma, Prateek},
	month = jul,
	year = {2024},
	pmid = {38235741},
	pages = {1383--1391},
}

@article{soleymanjahi_artificial_2024-1,
	title = {Artificial {Intelligence}–{Assisted} {Colonoscopy} for {Polyp} {Detection}},
	issn = {0003-4819},
	url = {https://www.acpjournals.org/doi/10.7326/ANNALS-24-00981},
	doi = {10.7326/ANNALS-24-00981},
	abstract = {Background:Randomized clinical trials (RCTs) of computer-aided detection (CADe) system–enhanced colonoscopy compared with conventional colonoscopy suggest increased adenoma detection rate (ADR) and decreased adenoma miss rate (AMR), but the effect on detection of advanced colorectal neoplasia (ACN) is unclear.Purpose:To conduct a systematic review to compare performance of CADe-enhanced and conventional colonoscopy.Data Sources:Cochrane Library, Google Scholar, Ovid EMBASE, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection databases were searched through February 2024.Study Selection:Published RCTs comparing CADe-enhanced and conventional colonoscopy.Data Extraction:Average adenoma per colonoscopy (APC) and ACN per colonoscopy were primary outcomes. Adenoma detection rate, AMR, and ACN detection rate (ACN DR) were secondary outcomes. Balancing outcomes included withdrawal time and resection of nonneoplastic polyps (NNPs). Subgroup analyses were done by neural network architecture.Data Synthesis:Forty-four RCTs with 36 201 cases were included. Computer-aided detection–enhanced colonoscopies have higher average APC (12 090 of 12 279 [0.98] vs. 9690 of 12 292 [0.78], incidence rate difference [IRD] = 0.22 [95\% CI, 0.16 to 0.28]) and higher ADR (7098 of 16 253 [44.7\%] vs. 5825 of 15 855 [36.7\%], rate ratio [RR] = 1.21 [CI, 1.15 to 1.28]). Average ACN per colonoscopy was similar (1512 of 9296 [0.16] vs. 1392 of 9121 [0.15], IRD = 0.01 [CI, −0.01 to 0.02]), but ACN DR was higher with CADe system use (1260 of 9899 [12.7\%] vs. 1119 of 9746 [11.5\%], RR = 1.16 [CI, 1.02 to 1.32]). Using CADe systems resulted in resection of almost 2 extra NNPs per 10 colonoscopies and longer total withdrawal time (0.53 minutes [CI, 0.30 to 0.77]).Limitation:Statistically significant heterogeneity in quality and sample size and inability to blind endoscopists to the intervention in included studies may affect the performance estimates.Conclusion:Computer-aided detection–enhanced colonoscopies have increased APC and detection rate but no difference in ACN per colonoscopy and a small increase in ACN DR. There is minimal increase in procedure time and no difference in performance across neural network architectures.Primary Funding Source:None. (PROSPERO: CRD42023422835)},
	urldate = {2024-11-04},
	journal = {Annals of Internal Medicine},
	author = {Soleymanjahi, Saeed and Huebner, Jack and Elmansy, Lina and Rajashekar, Niroop and Lüdtke, Nando and Paracha, Rumzah and Thompson, Rachel and Grimshaw, Alyssa A. and Foroutan, Farid and Sultan, Shahnaz and Shung, Dennis L.},
	month = oct,
	year = {2024},
	note = {publisher: American College of Physicians},
}

@article{lau_effect_2024,
	title = {Effect of {Real}-{Time} {Computer}-{Aided} {Polyp} {Detection} {System} ({ENDO}-{AID}) on {Adenoma} {Detection} in {Endoscopists}-in-{Training}: {A} {Randomized} {Trial}},
	volume = {22},
	issn = {1542-7714},
	shorttitle = {Effect of {Real}-{Time} {Computer}-{Aided} {Polyp} {Detection} {System} ({ENDO}-{AID}) on {Adenoma} {Detection} in {Endoscopists}-in-{Training}},
	doi = {10.1016/j.cgh.2023.10.019},
	abstract = {BACKGROUND: The effect of computer-aided polyp detection (CADe) on adenoma detection rate (ADR) among endoscopists-in-training remains unknown.
METHODS: We performed a single-blind, parallel-group, randomized controlled trial in Hong Kong between April 2021 and July 2022 (NCT04838951). Eligible subjects undergoing screening/surveillance/diagnostic colonoscopies were randomized 1:1 to receive colonoscopies with CADe (ENDO-AID[OIP-1]) or not (control) during withdrawal. Procedures were performed by endoscopists-in-training with {\textless}500 procedures and {\textless}3 years' experience. Randomization was stratified by patient age, sex, and endoscopist experience (beginner vs intermediate level, {\textless}200 vs 200-500 procedures). Image enhancement and distal attachment devices were disallowed. Subjects with incomplete colonoscopies or inadequate bowel preparation were excluded. Treatment allocation was blinded to outcome assessors. The primary outcome was ADR. Secondary outcomes were ADR for different adenoma sizes and locations, mean number of adenomas, and non-neoplastic resection rate.
RESULTS: A total of 386 and 380 subjects were randomized to CADe and control groups, respectively. The overall ADR was significantly higher in the CADe group than in the control group (57.5\% vs 44.5\%; adjusted relative risk, 1.41; 95\% CI, 1.17-1.72; P {\textless} .001). The ADRs for {\textless}5 mm (40.4\% vs 25.0\%) and 5- to 10-mm adenomas (36.8\% vs 29.2\%) were higher in the CADe group. The ADRs were higher in the CADe group in both the right colon (42.0\% vs 30.8\%) and left colon (34.5\% vs 27.6\%), but there was no significant difference in advanced ADR. The ADRs were higher in the CADe group among beginner (60.0\% vs 41.9\%) and intermediate-level (56.5\% vs 45.5\%) endoscopists. Mean number of adenomas (1.48 vs 0.86) and non-neoplastic resection rate (52.1\% vs 35.0\%) were higher in the CADe group.
CONCLUSIONS: Among endoscopists-in-training, the use of CADe during colonoscopies was associated with increased overall ADR. (ClinicalTrials.gov, Number: NCT04838951).},
	language = {eng},
	number = {3},
	journal = {Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association},
	author = {Lau, Louis H. S. and Ho, Jacky C. L. and Lai, Jimmy C. T. and Ho, Agnes H. Y. and Wu, Claudia W. K. and Lo, Vincent W. H. and Lai, Carol M. S. and Scheppach, Markus W. and Sia, Felix and Ho, Kyle H. K. and Xiao, Xiang and Yip, Terry C. F. and Lam, Thomas Y. T. and Kwok, Hanson Y. H. and Chan, Heyson C. H. and Lui, Rashid N. and Chan, Ting-Ting and Wong, Marc T. L. and Ho, Man-Fung and Ko, Rachel C. W. and Hon, Sok-Fei and Chu, Simon and Futaba, Koari and Ng, Simon S. M. and Yip, Hon-Chi and Tang, Raymond S. Y. and Wong, Vincent W. S. and Chan, Francis K. L. and Chiu, Philip W. Y. and {ENDOAID-TRAIN study group}},
	month = mar,
	year = {2024},
	pmid = {37918685},
	pages = {630--641.e4},
}

@article{tiankanon_improvement_2024,
	title = {Improvement of adenoma detection rate by two computer-aided colonic polyp detection systems in high adenoma detectors: a randomized multicenter trial},
	volume = {56},
	issn = {1438-8812},
	shorttitle = {Improvement of adenoma detection rate by two computer-aided colonic polyp detection systems in high adenoma detectors},
	doi = {10.1055/a-2210-7999},
	abstract = {BACKGROUND: This study aimed to evaluate the benefits of a self-developed computer-aided polyp detection system (SD-CADe) and a commercial system (CM-CADe) for high adenoma detectors compared with white-light endoscopy (WLE) as a control.
METHODS: Average-risk 50-75-year-old individuals who underwent screening colonoscopy at five referral centers were randomized to SD-CADe, CM-CADe, or WLE groups (1:1:1 ratio). Trainees and staff with an adenoma detection rate (ADR) of ≥35\% were recruited. The primary outcome was ADR. Secondary outcomes were the proximal adenoma detection rate (pADR), advanced adenoma detection rate (AADR), and the number of adenomas, proximal adenomas, and advanced adenomas per colonoscopy (APC, pAPC, and AAPC, respectively).
RESULTS: The study enrolled 1200 participants. The ADR in the control, CM-CADe, and SD-CADe groups was 38.3\%, 50.0\%, and 54.8\%, respectively. The pADR was 23.0\%, 32.3\%, and 38.8\%, respectively. AADR was 6.0\%, 10.3\%, and 9.5\%, respectively. After adjustment, the ADR and pADR in both intervention groups were significantly higher than in controls (all P{\textless}0.05). The APC in the control, CM-CADe, and SD-CADe groups was 0.66, 1.04, and 1.16, respectively. The pAPC was 0.33, 0.53, and 0.64, respectively, and the AAPC was 0.07, 0.12, and 0.10, respectively. Both CADe systems showed significantly higher APC and pAPC than WLE. AADR and AAPC were improved in both CADe groups versus control, although the differences were not statistically significant.
CONCLUSION: Even in high adenoma detectors, CADe significantly improved ADR and APC. The AADR tended to be higher with both systems, and this may enhance colorectal cancer prevention.},
	language = {eng},
	number = {4},
	journal = {Endoscopy},
	author = {Tiankanon, Kasenee and Aniwan, Satimai and Kerr, Stephen J. and Mekritthikrai, Krittaya and Kongtab, Natanong and Wisedopas, Naruemon and Piyachaturawat, Panida and Kulpatcharapong, Santi and Linlawan, Sittikorn and Phromnil, Poonrada and Muangpaisarn, Puth and Orprayoon, Theerapat and Chanyaswad, Jaruwan and Sunthornwechapong, Panukorn and Vateekul, Peerapon and Kullavanijaya, Pinit and Rerknimitr, Rungsun},
	month = apr,
	year = {2024},
	pmid = {37963587},
	pages = {273--282},
}

@article{penz_association_2024,
	title = {Association between endoscopist adenoma detection rate and serrated polyp detection: {Retrospective} analysis of over 200,000 screening colonoscopies},
	volume = {12},
	issn = {2364-3722},
	shorttitle = {Association between endoscopist adenoma detection rate and serrated polyp detection},
	doi = {10.1055/a-2271-1929},
	abstract = {Background and study aims Serrated lesions have been identified as precursor lesions for 20\% to 35\% of colorectal cancers (CRCs) and may contribute to a significant proportion of interval-cancer. Sessile-serrated-lesions (SSLs), in particular, tend to be flat and located in the proximal colon, making their detection challenging and requiring expertise. It remains unclear whether the detection rate for serrated polyps should be considered as a quality indicator in addition to the adenoma detection rate (ADR). This study sought to assess whether the ADR has an effect on the detection rate for serrated polyps.
 
atients and methods In this retrospective analysis, prospectively collected data from 212,668 screening colonoscopies performed between 2012 and September 2018 were included. Spearman correlation and Whitney-Mann U-test were used to assess the association of ADR and the detection rate of SSLs with (SDR) and without hyperplastic polyps (SPADRs), the sessile serrated detection rate (SSLDR) as well as the clinically relevant serrated detection rate (CRSDR), including all SSLs and traditional serrated adenoma, hyperplastic polyps (HPs) {\textgreater}10 mm anywhere in the colon or HPs {\textgreater} 5 mm proximal to the sigmoid.
 
Results The overall mean ADR was 21.78\% (standard deviation [SD] 9.27), SDR 21.08\% (SD 11.44), SPADR 2.19\% (SD 2.49), and CRSDR was 3.81\% (3.40). Significant correlations were found between the ADR and the SDR, SPADR, SSLDR, and CRSDR (rho=0.73 vs. rho=0.51 vs. rho=0.51 vs. rho=0.63; all P {\textless}0.001). Endoscopists with a mean ADR ≥25\% had significantly higher SDR, SPADR, and CRSDR than endoscopists with a mean ADR {\textless}25\% (all P {\textless}0.001; Mann-Whitney U-Test).
 
Conclusions This study shows that endoscopists with higher ADR detect significantly more serrated lesions than those with a lower ADR.},
	language = {en},
	journal = {Endoscopy International Open},
	author = {Penz, Daniela and Pammer, Daniel and Waldmann, Elisabeth and Asaturi, Arno and Szymanska, Aleksrandra and Trauner, Michael and Ferlitsch, Monika},
	month = apr,
	year = {2024},
	note = {publisher: Georg Thieme Verlag KG},
	pages = {E488--E497},
}

@article{vavricka_monitoring_2016,
	title = {Monitoring colonoscopy withdrawal time significantly improves the adenoma detection rate and the performance of endoscopists},
	volume = {48},
	issn = {0013-726X, 1438-8812},
	doi = {10.1055/s-0035-1569674},
	abstract = {Background and study aims: The recommended minimum withdrawal time for screening colonoscopy is 6 minutes. Adenoma detection rates (ADRs) increase with longer withdrawal times. We aimed to compare withdrawal times and ADRs of endoscopists unaware of being monitored vs. aware.

  Patients and methods: Seven experienced gastroenterologists prospectively performed 558 screening colonoscopies during a 9-month period in a Swiss University hospital. Colonoscopy withdrawal times were first measured without the gastroenterologists’ knowledge of being monitored (n = 355 colonoscopies) and then with their knowledge (n = 203 colonoscopies).

  Results: The median withdrawal time when gastroenterologists were unaware of being monitored was 4.5 minutes (interquartile range [IQR] 4 – 5.5 minutes) without intervention and 6 minutes (IQR 4 – 9 minutes) with intervention, increasing significantly to 7.3 minutes (IQR 6.5 – 9 minutes) and 8 minutes (IQR 7 – 11 minutes), respectively, when they were aware of being monitored (P P P  Conclusions: Colonoscopy withdrawal time in unmonitored gastroenterologists is shorter than recommended and increases with awareness of monitoring. ADR significantly increases when gastroenterologists are aware of being monitored. Implementation of systematic monitoring, and analysis of withdrawal time and ADR for each endoscopist may help to increase the ADR.},
	language = {en},
	number = {3},
	journal = {Endoscopy},
	author = {Vavricka, Stephan R. and Sulz, Michael C. and Degen, Lukas and Rechner, Roman and Manz, Michael and Biedermann, Luc and Beglinger, Christoph and Peter, Shajan and Safroneeva, Ekaterina and Rogler, Gerhard and Schoepfer, Alain M.},
	month = mar,
	year = {2016},
	note = {publisher: © Georg Thieme Verlag KG},
	pages = {256--262},
}

@article{brenner_trends_2015,
	title = {Trends in {Adenoma} {Detection} {Rates} {During} the {First} 10 {Years} of the {German} {Screening} {Colonoscopy} {Program}},
	volume = {149},
	issn = {1528-0012},
	doi = {10.1053/j.gastro.2015.04.012},
	abstract = {BACKGROUND \& AIMS: The adenoma detection rate (ADR) is an important quality indicator of screening colonoscopy; it is inversely associated with risk of interval cancers and colorectal cancer mortality. We assessed trends in the ADR in the first 10 years of the German screening colonoscopy program.
METHODS: We calculated age-adjusted and age-specific detection rates of nonadvanced adenomas and advanced adenomas for each calendar year based on 4.4 million screening colonoscopies conducted from 2003 through 2012 and reported to the German screening colonoscopy registry.
RESULTS: We observed a steady and strong increase in rate of detection of nonadvanced adenomas in both sexes and all age groups. Age-adjusted rates of detection of nonadvanced adenomas increased from 13.3\% to 22.3\% among men and from 8.4\% to 14.9\% among women. This increase was mostly due to an increase in detection rates of adenomas {\textless}0.5 cm, and it is partly explained by an innovation effect (higher ADRs among incoming colonoscopists than among leaving colonoscopists, and relatively stable ADRs among continuing colonoscopists). Only modest increases were observed in detection rates of advanced adenomas (from 7.4\% to 9.0\% among men, and from 4.4\% to 5.2\% among women) and colorectal cancer. In 2012, overall ADR reached 31.3\% and 20.1\% in men and women, respectively.
CONCLUSIONS: We observed a strong increase in ADRs from 2003 through 2012 in Germany. Although we cannot exclude the effects of secular trends in colorectal neoplasm prevalence, the observed increase was mainly the result of a steady increase in detection of nonadvanced adenomas (especially adenomas {\textless}0.5 cm). Further research should address potential implications for defining screening and surveillance intervals.},
	language = {eng},
	number = {2},
	journal = {Gastroenterology},
	author = {Brenner, Hermann and Altenhofen, Lutz and Kretschmann, Jens and Rösch, Thomas and Pox, Christian and Stock, Christian and Hoffmeister, Michael},
	month = aug,
	year = {2015},
	pmid = {25911510},
	pages = {356--366.e1},
}

@article{wang_artificial_2025,
	title = {Artificial intelligence for reducing missed detection of adenomas and polyps in colonoscopy: {A} systematic review and meta-analysis},
	volume = {31},
	issn = {1007-9327},
	shorttitle = {Artificial intelligence for reducing missed detection of adenomas and polyps in colonoscopy},
	url = {https://pmc.ncbi.nlm.nih.gov/articles/PMC12175867/},
	doi = {10.3748/wjg.v31.i21.105753},
	abstract = {BACKGROUND
Colorectal cancer has a high incidence and mortality rate, and the effectiveness of routine colonoscopy largely depends on the endoscopist’s expertise. In recent years, computer-aided detection (CADe) systems have been increasingly integrated into colonoscopy to improve detection accuracy. However, while most studies have focused on adenoma detection rate (ADR) as the primary outcome, the more sensitive adenoma miss rate (AMR) has been less frequently analyzed.

AIM
To evaluate the effectiveness of CADe in colonoscopy and assess the advantages of AMR over ADR.

METHODS
A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials using predefined search strategies to identify relevant studies published up to August 2, 2024. Statistical analyses were performed to compare outcomes between groups, and potential publication bias was assessed using funnel plots. The quality of the included studies was evaluated using the Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS
Five studies comprising 1624 patients met the inclusion criteria. AMR was significantly lower in the CADe-assisted group than in the routine colonoscopy group (147/927, 15.9\% vs 345/960, 35.9\%; P {\textless} 0.01). However, CADe did not provide a significant advantage in detecting advanced adenomas or lesions measuring 6-9 mm or ≥ 10 mm. The polyp miss rate (PMR) was also lower in the CADe-assisted group [odds ratio (OR), 0.35; 95\% confidence interval (CI): 0.23-0.52; P {\textless} 0.01]. While the overall ADR did not differ significantly between groups, the ADR during the first-pass examination was higher in the CADe-assisted group (OR, 1.37; 95\%CI: 1.10-1.69; P = 0.004). The level of evidence for the included randomized controlled trials was graded as moderate.

CONCLUSION
CADe can significantly reduce AMR and PMR while improving ADR during initial detection, demonstrating its potential to enhance colonoscopy performance. These findings highlight the value of CADe in improving the detection of colorectal neoplasms, particularly small and histologically distinct adenomas.},
	number = {21},
	urldate = {2025-09-22},
	journal = {World Journal of Gastroenterology},
	author = {Wang, Sheng-Yu and Gao, Jia-Cheng and Wu, Shuo-Dong},
	month = jun,
	year = {2025},
	pmid = {40538513},
	pmcid = {PMC12175867},
	pages = {105753},
}

@article{spadaccini_artificial_2025,
	title = {Artificial intelligence and colorectal neoplasia detection performances in patients with positive fecal immunochemical test: {Meta}-analysis and systematic review},
	volume = {37},
	copyright = {© 2025 Japan Gastroenterological Endoscopy Society.},
	issn = {1443-1661},
	shorttitle = {Artificial intelligence and colorectal neoplasia detection performances in patients with positive fecal immunochemical test},
	url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/den.15034},
	doi = {10.1111/den.15034},
	abstract = {Objectives The combination of fecal immunochemical test (FIT) followed by colonoscopy has established itself as one of the preferred population-based screening strategies. Despite extensive exploration of various techniques and technologies, their impact on adenoma detection rate has shown inconsistency across studies in this specific setting “FIT+ population.” We aimed to assess the impact of the computer-aided detection (CADe) system in all randomized trials focused on this subpopulation. Methods We searched MEDLINE, EMBASE, and Scopus databases until September 2023 for randomized controlled trials reporting diagnostic accuracy of CADe systems for detection of colorectal neoplasia. The primary outcome was pooled adenoma detection rate, and secondary outcomes were adenoma per colonoscopy, advanced adenoma per colonoscopy, serrated lesions, and nonneoplastic per colonoscopy. Results Ten randomized trials on 5421 patients were included. Adenoma detection rate was higher in the CADe group than in the standard colonoscopy group (0.62 vs. 0.52; relative risk 1.19; 95\% confidence interval 1.08–1.31). CADe also resulted in higher detection performances of both adenomas (incidence rate ratio 1.16; 95\% confidence interval 1.09–1.24) and serrated lesions (incidence rate ratio, 1.20; 95\% confidence interval 1.05–1.38) at per-polyp analysis. No differences were found for advanced adenomas between the groups. On the other hand, more nonneoplastic polyps were removed in the CADe than the standard group (0.45 vs. 0.34; mean difference 0.06; P = 0.026) in a comparable inspection time. Conclusions The use of CADe during colonoscopy results in an increased detection of adenomas, and serrated lesions, in a FIT+ setting. The impact on advanced adenomas was not significant. Higher rates of unnecessary removal of nonneoplastic polyps were also reported.},
	language = {en},
	number = {8},
	urldate = {2025-09-22},
	journal = {Digestive Endoscopy},
	author = {Spadaccini, Marco and Hassan, Cesare and Mori, Yuichi and Halvorsen, Natalie and Gimeno-García, Antonio Z. and Nakashima, Hirotaka and Facciorusso, Antonio and Patel, Harsh K. and Antonelli, Giulio and Khalaf, Kareem and Rizkala, Tommy and Ramai, Daryl and Rondonotti, Emanuele and Kamba, Shunsuke and Maselli, Roberta and Correale, Loredana and Bretthauer, Michael and Bhandari, Pradeep and Sharma, Prateek and Rex, Douglas K. and Repici, Alessandro and Group, the CADe},
	year = {2025},
	note = {\_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/den.15034},
	keywords = {CRC screening, artificial intelligence, colorectal cancer, polyp/adenoma},
	pages = {815--823},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\2NRQX8RU\\Spadaccini et al. - 2025 - Artificial intelligence and colorectal neoplasia detection performances in patients with positive fe.pdf:application/pdf;Snapshot:C\:\\Users\\Tlux1\\Zotero\\storage\\BA33VA43\\den.html:text/html},
}

@article{waldmann_association_2021,
	title = {Association of {Adenoma} {Detection} {Rate} and {Adenoma} {Characteristics} {With} {Colorectal} {Cancer} {Mortality} {After} {Screening} {Colonoscopy}},
	volume = {19},
	issn = {1542-3565, 1542-7714},
	url = {https://www.cghjournal.org/article/S1542-3565(21)00457-2/fulltext},
	doi = {10.1016/j.cgh.2021.04.023},
	language = {English},
	number = {9},
	urldate = {2025-09-22},
	journal = {Clinical Gastroenterology and Hepatology},
	author = {Waldmann, Elisabeth and Kammerlander, Andreas A. and Gessl, Irina and Penz, Daniela and Majcher, Barbara and Hinterberger, Anna and Bretthauer, Michael and Trauner, Michael H. and Ferlitsch, Monika},
	month = sep,
	year = {2021},
	pmid = {33878471},
	note = {Publisher: Elsevier},
	keywords = {Quality Assurance, Risk Stratification After Polypectomy, Screening Colonoscopy, Surveillance After Colonoscopy, colorectal cancer, adenoma detection rate, ADR, CI, confidence interval, CRC, hazard ratio, HR},
	pages = {1890--1898},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\A2CT7RNB\\Waldmann et al. - 2021 - Association of Adenoma Detection Rate and Adenoma Characteristics With Colorectal Cancer Mortality A.pdf:application/pdf;ScienceDirect Snapshot:C\:\\Users\\Tlux1\\Zotero\\storage\\HHDJBD7C\\S1542356521004572.html:text/html},
}

@article{waldmann_trends_2016,
	title = {Trends in quality of screening colonoscopy in {Austria}},
	volume = {48},
	copyright = {© Georg Thieme Verlag KG Stuttgart · New York},
	issn = {0013-726X, 1438-8812},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-113185},
	doi = {10.1055/s-0042-113185},
	abstract = {{\textless}p{\textgreater} \textbf{Background and study aim:} Screening colonoscopy only effectively prevents colorectal cancer if performed with high quality. The aim of this study was to analyze the detection rates of premalignant colorectal lesions in screening colonoscopies performed within a nationwide quality control program for screening colonoscopy in Austria.{\textless}/p{\textgreater} {\textless}p{\textgreater} \textbf{Methods:} Data from electronic records of the screening program from its implementation in 2007 until December 2014 were analyzed in order to calculate detection rates for adenomas, advanced adenomas, polyps, and proximal lesions, and rates of cecal intubation, sedation, complications, and adequate bowel preparation. Results were evaluated to identify trends and changes in quality parameters over the 8-year study period.{\textless}/p{\textgreater} {\textless}p{\textgreater} \textbf{Results:} During the study period, 301 endoscopists provided data from 159 246 screening colonoscopies. Mean age of screened individuals was 61.1 years, and 49.1 \% were women. Significant increases over time were found for age- and sex-adjusted adenoma detection rates (ADRs), which increased from a mean of 22.2 \% (SD 10.7 \%) in 2007/2008 to 24.2 \% (SD 11.6 \%) in 2013/2014. On average, each endoscopist increased their individual ADR by + 1.5 percentage points per 2-year period (95 \% confidence interval [CI] 0.9 – 2.2 percentage points; \textit{P} {\textless} 0.01). Similarly, detection rates for proximal lesions rose from 15.8 \% (SD 9.8 \%) to 21.7 \% (SD 13.3 \% + 2.5 percentage points per 2-year period, 95 \%CI 1.9 – 3.1 percentage points; \textit{P} {\textless} 0.01). ADR in men increased from 27.6 \% in 2007/2008 (SD 11.1 \%) to 29.2 \% in 2013/2014 (SD 12.7 \%; \textit{P} {\textless} 0.01); ADR in women increased from 14.2 \% (SD 7.1 \%) in 2007/2008 to 19.0 \% (SD 10.5 \%) in 2013/2014 (\textit{P} {\textless} 0.01). Advanced adenoma detection rates decreased during the study period, from 11.4 \% (SD 9.0 \%) in 2007/2008 to 7.6 \% (SD 5.4 \%) in 2013/2014 (\textit{P} = 0.06) in men, and from 5.5 \% (SD 5.3 \%) in 2007/2008 to 4.0 \% (SD 4.1 \%) in 2013/2014 in women (\textit{P} = 0.21).{\textless}/p{\textgreater} {\textless}p{\textgreater} \textbf{Conclusions:} This study showed an improvement in the quality of screening colonoscopies performed within a quality assurance program in Austria between 2007 and 2014. Although, overall ADR increased significantly during the study period, there was a decrease in the rate of advanced adenoma detection.{\textless}/p{\textgreater}},
	language = {en},
	number = {12},
	urldate = {2025-09-22},
	journal = {Endoscopy},
	author = {Waldmann, Elisabeth and Gessl, Irina and Sallinger, Daniela and Jeschek, Philip and Britto-Arias, Martha and Heinze, Georg and Fasching, Elisabeth and Weiss, Werner and Gschwantler, Michael and Trauner, Michael and Ferlitsch, Monika},
	month = dec,
	year = {2016},
	note = {Publisher: © Georg Thieme Verlag KG},
	pages = {1102--1109},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\5QB4U53L\\Waldmann et al. - 2016 - Trends in quality of screening colonoscopy in Austria.pdf:application/pdf},
}

@article{prosenz_areas_2024,
	title = {Areas of improvement for colorectal cancer screening: {Results} of a screening initiative for 10,000 health care employees in {Austria}},
	volume = {12},
	copyright = {Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany},
	issn = {2364-3722, 2196-9736},
	shorttitle = {Areas of improvement for colorectal cancer screening},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/a-2462-0466},
	doi = {10.1055/a-2462-0466},
	abstract = {{\textless}p{\textgreater} \textbf{Background and study aims} Participation in and quality of colorectal cancer (CRC) screening varies greatly and it is unclear how much of CRC screening guideline quality metrics reach patients. The aims of this prospective observational study were to provide data from everyday practice in Austria.{\textless}/p{\textgreater} {\textless}p{\textgreater} \textbf{Patients and methods} All employees aged ≥ 50 years were invited and received a stool-based-test (FIT (cut-off 25 mcg Hb/g) and M2PK), which could be dropped off at the workplace. All individuals with positive tests were called and offered a colonoscopy near their workplace/home in ≤ 3 weeks performed by unselected endoscopists. Non-attendees received email and telephone reminders.{\textless}/p{\textgreater} {\textless}p{\textgreater} \textbf{Results} Of 10,239 eligible employees (2706 males, 7533 females), 2390 (23\%) (plus 673 {\textless} 50 years) median age 53 (interquartile range 50;56) participated in the stool-based screening (18\% males, 25\% females). Of 3063 tests, 747 (24\%) were positive. The follow-up rate for 616 individuals who accepted or eventually underwent colonoscopy was 84\% (n = 517). The adenoma detection rate (ADR) was 20.5\% (31\% in men, 17\% in women) and varied substantially, ranging from 15\% in hospitals (excluding the study center) to 18.5\% among office-based endoscopists, and up to 36\% in the study center. Most European Society of Gastrointestinal Endoscopy-recommended performance indicators were unmet, including the polyp detection rate (PDR), ADR, reporting of polyp characteristics, and bowel preparation adequacy.{\textless}/p{\textgreater} {\textless}p{\textgreater} \textbf{Conclusions} There is a serious gap between recommended standards and real-world CRC screening colonoscopy quality. Implementation of CRC screening should not only be accompanied by strategies to increase participation rates but focus on implementation of rigorous, mandatory colonoscopy quality assurance programs.{\textless}/p{\textgreater}},
	language = {en},
	number = {11},
	urldate = {2025-09-22},
	journal = {Endoscopy International Open},
	author = {Prosenz, Julian and Österreicher, Zoe Anne and Koutny, Florian and Asaturi, Arno and Birkl, Moira and Hanke, Rosanna and Ferlitsch, Monika and Maieron, Andreas},
	month = nov,
	year = {2024},
	note = {Publisher: Georg Thieme Verlag KG},
	keywords = {CRC screening, Endoscopy Lower GI Tract, Performance and complications, Polyps/adenomas/..., Quality and logistical aspects, Quality management},
	pages = {E1425--E1433},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\ZCYQB4DR\\Prosenz et al. - 2024 - Areas of improvement for colorectal cancer screening Results of a screening initiative for 10,000 h.pdf:application/pdf},
}

@article{van_toledo_serrated_2022,
	title = {Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study},
	volume = {7},
	issn = {2468-1253},
	shorttitle = {Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer},
	doi = {10.1016/S2468-1253(22)00090-5},
	abstract = {BACKGROUND: Adenoma detection rate (ADR) is a well-established quality indicator for colonoscopy and is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. However, interval post-colonoscopy colorectal cancers frequently develop from serrated polyps, which are not included in the ADR. Therefore, the proximal serrated polyp detection rate (PSPDR) has been proposed as a quality indicator, but its association with interval post-colonoscopy colorectal cancer has not been studied. We aimed to evaluate this potential association based on data collected in the Dutch colorectal cancer screening programme.
METHODS: In this population-based study, using colonoscopy data from the Dutch faecal immunochemical test-based colorectal cancer screening programme and cancer data from the Netherlands Cancer Registry, we evaluated the association between endoscopists' individual PSPDR and their patients' risk of interval post-colonoscopy colorectal cancer with a shared frailty Cox proportional-hazard regression analysis. Participants in the screening programme who were eligible for inclusion were aged 55-76 years, had a positive faecal immunochemical test (cutoff 15 μg Hb/g faeces at start and changed mid-2014 to 47 μg Hb/g faeces), were asymptomatic, and underwent a colonoscopy between Jan 1, 2014, and Dec 31, 2020. The PSPDR was defined as the proportion of colonoscopies in which at least one serrated polyp proximal to the descending colon was detected, confirmed by histopathology. The ADR was defined as the proportion of all colonoscopies in which at least one conventional adenoma was detected, confirmed by histopathology. Detection rates were determined for each endoscopist individually. We additionally evaluated the risk of interval post-colonoscopy colorectal cancer for endoscopists with a PSPDR and ADR above the median versus endoscopists with either one or both parameters below the median. This study is registered with the Netherlands Trial Registry, NL8350.
FINDINGS: During the study period, 329 104 colonoscopies were done, of which 277 555, done by 441 endoscopists, were included in the PSPDR calculations. The median PSPDR was 11·9\% (IQR 8·3-15·8) and median ADR was 66·3\% (61·4-69·9). The correlation between the PSDPR and ADR was moderate (r=0·59; p{\textless}0·0001). During a median follow-up of 33 months (IQR 21-42), 305 interval post-colonoscopy colorectal cancers were detected. For each percentage point increase in PSPDR, the adjusted interval post-colonoscopy colorectal cancer hazard was 7\% lower (hazard ratio [HR] 0·93, 95\% CI 0·90-0·95; p{\textless}0·0001). Compared with endoscopists with a PSPDR greater than 11·9\% and ADR greater than 66·3\%, the HR of interval post-colonoscopy colorectal cancer for endoscopists with a low PSPDR and high ADR was 1·79 (95\% CI 1·22-2·63), for endoscopists with a high PSPDR and low ADR was 1·97 (1·19-3·24), and for endoscopists with a low PSPDR and low ADR was 2·55 (1·89-3·45).
INTERPRETATION: The PSPDR of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer. Implementation of PSPDR monitoring, in addition to ADR monitoring, could optimise colorectal cancer prevention.
FUNDING: None.},
	language = {eng},
	number = {8},
	journal = {The Lancet. Gastroenterology \& Hepatology},
	author = {van Toledo, David E. F. W. M. and IJspeert, Joep E. G. and Bossuyt, Patrick M. M. and Bleijenberg, Arne G. C. and van Leerdam, Monique E. and van der Vlugt, Manon and Lansdorp-Vogelaar, Iris and Spaander, Manon C. W. and Dekker, Evelien},
	month = aug,
	year = {2022},
	pmid = {35550250},
	keywords = {Colonoscopy, Colorectal Neoplasms, Humans, Adenoma, Colonic Polyps, Early Detection of Cancer},
	pages = {747--754},
	file = {Volltext:C\:\\Users\\Tlux1\\Zotero\\storage\\3WNZCUBS\\van Toledo et al. - 2022 - Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer a population-based.pdf:application/pdf},
}

@article{foroutan_computer_2025,
	title = {Computer aided detection and diagnosis of polyps in adult patients undergoing colonoscopy: a living clinical practice guideline},
	volume = {388},
	issn = {1756-1833},
	shorttitle = {Computer aided detection and diagnosis of polyps in adult patients undergoing colonoscopy},
	doi = {10.1136/bmj-2024-082656},
	abstract = {CLINICAL QUESTION: In adult patients undergoing colonoscopy for any indication (screening, surveillance, follow-up of positive faecal immunochemical testing, or gastrointestinal symptoms such as blood in the stools) what are the benefits and harms of computer-aided detection (CADe)?
CONTEXT AND CURRENT PRACTICE: Colorectal cancer (CRC), the third most common cancer and the second leading cause of cancer-related death globally, typically arises from adenomatous polyps. Detection and removal of polyps during colonoscopy can reduce the risk of cancer. CADe systems use artificial intelligence (AI) to assist endoscopists by analysing real-time colonoscopy images to detect potential polyps. Despite their increasing use in clinical practice, guideline recommendations that carefully balance all patient-important outcomes remain unavailable. In this first iteration of a living guideline, we address the use of CADe at the level of an individual patient.
EVIDENCE: Evidence for this recommendation is drawn from a living systematic review of 44 randomised controlled trials (RCTs) involving more than 30 000 participants and a companion microsimulation study simulating 10 year follow-up for 100 000 individuals aged 60-69 years to assess the impact of CADe on patient-important outcomes. While no direct evidence was found for critical outcomes of colorectal cancer incidence and post-colonoscopy cancer incidence, low certainty data from the trials indicate that CADe may increase positive endoscopy findings. The microsimulation modelling, however, suggests little to no effect on CRC incidence, CRC-related mortality, or colonoscopy-related complications (perforation and bleeding) over the 10 year follow-up period, although low certainty evidence indicates CADe may increase the number of colonoscopies performed per patient. A review of values and preferences identified that patients value mortality reduction and quality of care but worry about increased anxiety, overdiagnosis, and more frequent surveillance.
RECOMMENDATION: For adults who have agreed to undergo colonoscopy, we suggest against the routine use of CADe (weak recommendation).
HOW THIS GUIDELINE WAS CREATED: An international panel, including three patient partners, 11 healthcare providers, and seven methodologists, deemed by MAGIC and The BMJ to have no relevant competing interests, developed this recommendation. For this guideline the panel took an individual patient approach. The panel started by defining the clinical question in PICO format, and prioritised outcomes including CRC incidence and mortality. Based on the linked systematic review and microsimulation study, the panel sought to balance the benefits, harms, and burdens of CADe and assumed patient preferences when making this recommendation UNDERSTANDING THE RECOMMENDATION: The guideline panel found the benefits of CADe on critical outcomes, such as CRC incidence and post-colonoscopy cancer incidence, over a 10 year follow up period to be highly uncertain. Low certainty evidence suggests little to no impact on CRC-related mortality, while the potential burdens-including more frequent surveillance colonoscopies-are likely to affect many patients. Given the small and uncertain benefits and the likelihood of burdens, the panel issued a weak recommendation against routine CADe use.The panel acknowledges the anticipated variability in values and preferences among patients and clinicians when considering these uncertain benefits and potential burdens. In healthcare settings where CADe is available, individual decision making may be appropriate.
UPDATES: This is the first iteration of a living practice guideline. The panel will update this living guideline if ongoing evidence surveillance identifies new CADe trial data that substantially alters our conclusions about CRC incidence, mortality, or burdens, or studies that increase our certainty in values and preferences of individual patients. Updates will provide recommendations on the use of CADe from a healthcare systems perspective (including resource use, acceptability, feasibility, and equity), as well as the combined use of CADe and computer aided diagnosis (CADx). Users can access the latest guideline version and supporting evidence on MAGICapp, with updates periodically published in The BMJ.},
	language = {eng},
	journal = {BMJ (Clinical research ed.)},
	author = {Foroutan, Farid and Vandvik, Per Olav and Helsingen, Lise M. and Kalager, Mette and Rutter, Matt and Selby, Kevin and Pilonis, Nastazja Dagny and Anderson, Joseph C. and McKinnon, Annette and Fuchs, Jonathan M. and Quinlan, Casey and Buskermolen, Maaike and Senore, Carlo and Wang, Pu and Sung, Joseph J. Y. and Haug, Ulrike and Bjerkelund, Silje and Triantafyllou, Konstantinos and Shung, Dennis L. and Halvorsen, Natalie and McGinn, Thomas and Hafver, Tandekile Lubelwana and Reinthaler, Valerie and Guyatt, Gordon and Agoritsas, Thomas and Sultan, Shahnaz},
	month = mar,
	year = {2025},
	pmid = {40147837},
	keywords = {Colonoscopy, Colorectal Neoplasms, Humans, Colonic Polyps, Early Detection of Cancer, Adult, Aged, Artificial Intelligence, Diagnosis, Computer-Assisted, Female, Male, Middle Aged, Practice Guidelines as Topic},
	pages = {e082656},
}

@article{zimmermann-fraedrich_no_2025,
	title = {No {Effect} of {Computer}-{Aided} {Diagnosis} on {Colonoscopic} {Adenoma} {Detection} in a {Large} {Pragmatic} {Multicenter} {Randomized} {Study}},
	issn = {1572-0241},
	doi = {10.14309/ajg.0000000000003500},
	abstract = {INTRODUCTION: Multiple randomized studies have demonstrated that computer-assisted detection (CADe) improves the colonoscopic adenoma detection rate (ADR); however, these improvements have not been consistently reproduced in some more recent studies.
METHODS: Patients aged 50 years and older undergoing outpatient colonoscopy in 12 German institutions were randomized to either the CADe group or the control group. The primary outcome parameter was the ADR, while secondary outcomes included the adenomas per colonoscopy rate, detection rates of different histologic subgroups, and adverse events. The median examiner-specific observed rates and examiner-adjusted rates were compared between treatment groups.
RESULTS: One thousand six hundred twenty-seven patients were included (mean age 63.1 years, 39.8\% female; 71\% screening indications). The observed median examiner ADR was 40.0\% (interquartile range 20.0\%-57.1\%) in the study vs 37.5\% (inter-quartile range 20.0\%-50.0\%) in the control group. Similarly, adjusted overall ADR was 40.6\% (95\% confidence interval [CI]: 35.8\%, 45.5\%) in the study and 38.3\% (95\% CI: 33.5\%, 43.1\%) in the control group. No differences were observed in adenomas per colonoscopy or any of the adenoma subgroups with regard to size, morphology, location, and histology as well as colonoscopy indication. The examiner had a large influence on ADR (adjusted median odds ratio [OR] 1.32), similar to patient age (OR per 10-year increase 1.40, 95\% CI: 1.23-1.59) and sex (OR 1.62, 95\% CI: 1.30-2.04). On the other hand, more hyperplastic polyps were found by CADe (OR for adjusted hyperplastic polyp detection rate = 1.29; 95\% CI: 1.02-1.63; P = 0.033).
DISCUSSION: In patients older than 50 years with mixed colonoscopy indications, CADe did not increase the ADR. Further studies should define the requirements for selective CADe use in routine clinical practice, particularly in relation to the examiner's baseline ADR.},
	language = {eng},
	journal = {The American Journal of Gastroenterology},
	author = {Zimmermann-Fraedrich, Katharina and Sehner, Susanne and Rösch, Thomas and Aschenbeck, Jens and Schubert, Stefan and Liceni, Thomas and Moog, Gero and Neumann, Helmut and Berndt, Rüdiger and Weigt, Jochen and Kaczmarek, Dominik J. and May, Andrea and Hoffmeister, Albrecht and Möschler, Oliver and Wiessner, Christian and Schachschal, Guido},
	month = apr,
	year = {2025},
	pmid = {40293139},
	keywords = {colonoscopy, artificial intelligence, colorectal cancer screening},
}

@book{bagaric_checklisten_2025,
	title = {Checklisten {Intensivpflege}},
	isbn = {978-3-437-05474-7},
	abstract = {Alles Wichtige auf einen Blick Die Checklisten Intensivpflege bieten eine übersichtliche Zusammenfassung der häufigsten Krankheitsbilder, die eine intensivmedizinische Versorgung erfordern. Vom Abdominellen Aortenaneurysma über HELLP-Syndrom und Sepsis bis hin zur Zyanose erfahren Intensivpflegekräfte und Pflegende in der Weiterbildung, alphabetisch geordnet, alles über - Definition und gängige Synonyme des Krankheitsbilds - Ursachen, Symptome, Diagnostik und Therapie - Hinweise zur Pflege, z.B. Patientenbeobachtung und spezielle Pflegehandlungen - Wichtige Zusatzinformationen und HinweiseZusätzlich enthalten die Checklisten eigene Kapitel zu speziellen Pflegemaßnahmen in der Intensivpflege wie Bauchpositionierung und Weaning sowie zu wichtigen Arzneimittelgruppen.Die Checklisten Intensivpflege sind perfekt geeignet zum schnellen Nachschlagen in der Praxis und zur Wiederholung von Prüfungswissen!},
	language = {de},
	publisher = {Elsevier Health Sciences},
	author = {Bagaric, Mario and Kany, Anke},
	month = jan,
	year = {2025},
	note = {Google-Books-ID: BTUzEQAAQBAJ},
	keywords = {Medical / Nursing / Fundamentals \& Skills},
}

@article{kaminski_performance_2017,
	title = {Performance measures for lower gastrointestinal endoscopy: a {European} {Society} of {Gastrointestinal} {Endoscopy} ({ESGE}) {Quality} {Improvement} {Initiative}},
	volume = {49},
	copyright = {© Georg Thieme Verlag KG Stuttgart · New York},
	issn = {0013-726X, 1438-8812},
	shorttitle = {Performance measures for lower gastrointestinal endoscopy},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-103411},
	doi = {10.1055/s-0043-103411},
	abstract = {{\textless}p{\textgreater}The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level:{\textless}/p{\textgreater} {\textless}p{\textgreater} \textbf{1} Rate of adequate bowel preparation (minimum standard 90 \%); \textbf{2} Cecal intubation rate (minimum standard 90 \%); \textbf{3} Adenoma detection rate (minimum standard 25 \%); \textbf{4 }Appropriate polypectomy technique (minimum standard 80 \%); \textbf{5} Complication rate (minimum standard not set); \textbf{6} Patient experience (minimum standard not set); \textbf{7} Appropriate post-polypectomy surveillance recommendations (minimum standard not set). {\textless}/p{\textgreater} {\textless}p{\textgreater}Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.{\textless}/p{\textgreater}},
	language = {en},
	number = {04},
	urldate = {2025-10-06},
	journal = {Endoscopy},
	author = {Kaminski, Michal F. and Thomas-Gibson, Siwan and Bugajski, Marek and Bretthauer, Michael and Rees, Colin J. and Dekker, Evelien and Hoff, Geir and Jover, Rodrigo and Suchanek, Stepan and Ferlitsch, Monika and Anderson, John and Roesch, Thomas and Hultcranz, Rolf and Racz, Istvan and Kuipers, Ernst J. and Garborg, Kjetil and East, James E. and Rupinski, Maciej and Seip, Birgitte and Bennett, Cathy and Senore, Carlo and Minozzi, Silvia and Bisschops, Raf and Domagk, Dirk and Valori, Roland and Spada, Cristiano and Hassan, Cesare and Dinis-Ribeiro, Mario and Rutter, Matthew D.},
	month = apr,
	year = {2017},
	note = {Publisher: © Georg Thieme Verlag KG},
	pages = {378--397},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\ZEGYI2TP\\Kaminski et al. - 2017 - Performance measures for lower gastrointestinal endoscopy a European Society of Gastrointestinal En.pdf:application/pdf},
}

@article{noauthor_german_2019,
	title = {German {Guideline} {Program} in {Oncology} ({German} {Cancer} {Society}, {German} {Cancer} {Aid}, {AWMF}): {S3}-{Guideline} {Colorectal} {Cancer}, long version 2.1, 2019, {AWMF} registrationnumber: 021-{007OL}},
	url = {http://www.leitlinienprogramm- onkologie.de/leitlinien/kolorektales-karzinom/},
	language = {en},
	year = {2019},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\Q4NZIXHL\\2019 - Evidenced-based Guideline for Colorectal Cancer.pdf:application/pdf},
}

@article{wang_effect_2020-1,
	title = {Effect of a deep-learning computer-aided detection system on adenoma detection during colonoscopy ({CADe}-{DB} trial): a double-blind randomised study},
	volume = {5},
	issn = {2468-1253, 2468-1156},
	shorttitle = {Effect of a deep-learning computer-aided detection system on adenoma detection during colonoscopy ({CADe}-{DB} trial)},
	url = {https://www.thelancet.com/journals/langas/article/PIIS2468-1253(19)30411-X/abstract},
	doi = {10.1016/S2468-1253(19)30411-X},
	language = {English},
	number = {4},
	urldate = {2025-10-06},
	journal = {The Lancet Gastroenterology \& Hepatology},
	author = {Wang, Pu and Liu, Xiaogang and Berzin, Tyler M. and Brown, Jeremy R. Glissen and Liu, Peixi and Zhou, Chao and Lei, Lei and Li, Liangping and Guo, Zhenzhen and Lei, Shan and Xiong, Fei and Wang, Han and Song, Yan and Pan, Yan and Zhou, Guanyu},
	month = apr,
	year = {2020},
	pmid = {31981517},
	note = {Publisher: Elsevier},
	pages = {343--351},
}

@article{kaminski_quality_2010,
	title = {Quality indicators for colonoscopy and the risk of interval cancer},
	volume = {362},
	issn = {1533-4406},
	doi = {10.1056/NEJMoa0907667},
	abstract = {BACKGROUND: Although rates of detection of adenomatous lesions (tumors or polyps) and cecal intubation are recommended for use as quality indicators for screening colonoscopy, these measurements have not been validated, and their importance remains uncertain.
METHODS: We used a multivariate Cox proportional-hazards regression model to evaluate the influence of quality indicators for colonoscopy on the risk of interval cancer. Data were collected from 186 endoscopists who were involved in a colonoscopy-based colorectal-cancer screening program involving 45,026 subjects. Interval cancer was defined as colorectal adenocarcinoma that was diagnosed between the time of screening colonoscopy and the scheduled time of surveillance colonoscopy. We derived data on quality indicators for colonoscopy from the screening program's database and data on interval cancers from cancer registries. The primary aim of the study was to assess the association between quality indicators for colonoscopy and the risk of interval cancer.
RESULTS: A total of 42 interval colorectal cancers were identified during a period of 188,788 person-years. The endoscopist's rate of detection of adenomas was significantly associated with the risk of interval colorectal cancer (P=0.008), whereas the rate of cecal intubation was not significantly associated with this risk (P=0.50). The hazard ratios for adenoma detection rates of less than 11.0\%, 11.0 to 14.9\%, and 15.0 to 19.9\%, as compared with a rate of 20.0\% or higher, were 10.94 (95\% confidence interval [CI], 1.37 to 87.01), 10.75 (95\% CI, 1.36 to 85.06), and 12.50 (95\% CI, 1.51 to 103.43), respectively (P=0.02 for all comparisons).
CONCLUSIONS: The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy.},
	language = {eng},
	number = {19},
	journal = {The New England Journal of Medicine},
	author = {Kaminski, Michal F. and Regula, Jaroslaw and Kraszewska, Ewa and Polkowski, Marcin and Wojciechowska, Urszula and Didkowska, Joanna and Zwierko, Maria and Rupinski, Maciej and Nowacki, Marek P. and Butruk, Eugeniusz},
	month = may,
	year = {2010},
	pmid = {20463339},
	keywords = {Colonoscopy, Colorectal Neoplasms, Humans, Adenoma, Colonic Polyps, Early Detection of Cancer, Adult, Aged, Middle Aged, Clinical Competence, Multivariate Analysis, Poland, Proportional Hazards Models, Quality Indicators, Health Care, Risk Factors},
	pages = {1795--1803},
}

@article{corley_adenoma_2014,
	title = {Adenoma detection rate and risk of colorectal cancer and death},
	volume = {370},
	issn = {1533-4406},
	doi = {10.1056/NEJMoa1309086},
	abstract = {BACKGROUND: The proportion of screening colonoscopic examinations performed by a physician that detect one or more adenomas (the adenoma detection rate) is a recommended quality measure. However, little is known about the association between this rate and patients' risks of a subsequent colorectal cancer (interval cancer) and death.
METHODS: Using data from an integrated health care delivery organization, we evaluated the associations between the adenoma detection rate and the risks of colorectal cancer diagnosed 6 months to 10 years after colonoscopy and of cancer-related death. With the use of Cox regression, our estimates of attributable risk were adjusted for the demographic characteristics of the patients, indications for colonoscopy, and coexisting conditions.
RESULTS: We evaluated 314,872 colonoscopies performed by 136 gastroenterologists; the adenoma detection rates ranged from 7.4 to 52.5\%. During the follow-up period, we identified 712 interval colorectal adenocarcinomas, including 255 advanced-stage cancers, and 147 deaths from interval colorectal cancer. The unadjusted risks of interval cancer according to quintiles of adenoma detection rates, from lowest to highest, were 9.8, 8.6, 8.0, 7.0, and 4.8 cases per 10,000 person-years of follow-up, respectively. Among patients of physicians with adenoma detection rates in the highest quintile, as compared with patients of physicians with detection rates in the lowest quintile, the adjusted hazard ratio for any interval cancer was 0.52 (95\% confidence interval [CI], 0.39 to 0.69), for advanced-stage interval cancer, 0.43 (95\% CI, 0.29 to 0.64), and for fatal interval cancer, 0.38 (95\% CI, 0.22 to 0.65). Each 1.0\% increase in the adenoma detection rate was associated with a 3.0\% decrease in the risk of cancer (hazard ratio, 0.97; 95\% CI, 0.96 to 0.98).
CONCLUSIONS: The adenoma detection rate was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. (Funded by the Kaiser Permanente Community Benefit program and the National Cancer Institute.).},
	language = {eng},
	number = {14},
	journal = {The New England Journal of Medicine},
	author = {Corley, Douglas A. and Jensen, Christopher D. and Marks, Amy R. and Zhao, Wei K. and Lee, Jeffrey K. and Doubeni, Chyke A. and Zauber, Ann G. and de Boer, Jolanda and Fireman, Bruce H. and Schottinger, Joanne E. and Quinn, Virginia P. and Ghai, Nirupa R. and Levin, Theodore R. and Quesenberry, Charles P.},
	month = apr,
	year = {2014},
	pmid = {24693890},
	pmcid = {PMC4036494},
	keywords = {Colonoscopy, Colorectal Neoplasms, Humans, Adenoma, Aged, Middle Aged, Risk, United States},
	pages = {1298--1306},
	file = {Akzeptierte Version:C\:\\Users\\Tlux1\\Zotero\\storage\\K53CBTNC\\Corley et al. - 2014 - Adenoma detection rate and risk of colorectal cancer and death.pdf:application/pdf},
}

@article{gotz_s2k-leitlinie_2017,
	title = {S2k-{Leitlinie} {Gastrointestinale} {Blutung}},
	volume = {55},
	copyright = {© Georg Thieme Verlag KG Stuttgart · New York},
	issn = {0044-2771, 1439-7803},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-116856},
	doi = {10.1055/s-0043-116856},
	abstract = {Thieme E-Books \& E-Journals},
	language = {de},
	number = {9},
	urldate = {2025-10-12},
	journal = {Zeitschrift für Gastroenterologie},
	author = {Götz, Martin and Anders, Mario and Biecker, Erwin and Bojarski, Christian and Braun, Georg and Brechmann, Thorsten and Dechêne, Alexander and Dollinger, Matthias and Gawaz, Meinrad and Kiesslich, Ralf and Schilling, Dieter and Tacke, Frank and Zipprich, Alexander and Trebicka, Jonel and Collaborators and Gastroenterologie, Deutsche Gesellschaft für and Stoffwechselkrankheiten (DGVS) (federführend), Verdauungs-und and Vereinigung (DCCV), Deutschen Morbus Crohn und Colitis ulcerosa and Röntgengesellschaft (DRG), Deutsche and Radiologie (DeGiR), Deutsche Gesellschaft für interventionelle and Dgav, Deutsche Gesellschaft für Allgemein-und Viszeralchirurgie (DGAV) und Chirurgische Arbeitsgemeinschaft für Endoskopie und Sonographie (CAES) der and Intensivmedizin (DGIIN), Deutsche Gesellschaft für Internistische and Medizin (DGIM), Deutsche Gesellschaft für Innere and Kardiologie (DGK), Deutsche Gesellschaft für and Medizin (AEM), Akademie für Ethik in der and Hämostaseforschung (GTH), Gesellschaft für Thrombose-und},
	month = sep,
	year = {2017},
	note = {Company: © Georg Thieme Verlag KG
Distributor: © Georg Thieme Verlag KG
Institution: © Georg Thieme Verlag KG
Label: © Georg Thieme Verlag KG
Publisher: © Georg Thieme Verlag KG},
	keywords = {Leitlinie},
	pages = {883--936},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\XDKADTGF\\Götz et al. - 2017 - S2k-Leitlinie Gastrointestinale Blutung.pdf:application/pdf},
}

@article{gotz_addendum_2022,
	title = {Addendum zur {S2k}-{Leitlinie} {Gastrointestinale} {Blutungen} der {Deutschen} {Gesellschaft} für {Gastroenterologie}, {Verdauungs}- und {Stoffwechselkrankheiten} ({DGVS})},
	volume = {60},
	copyright = {Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany},
	issn = {0044-2771, 1439-7803},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/a-1788-3501},
	doi = {10.1055/a-1788-3501},
	abstract = {Thieme E-Books \& E-Journals},
	language = {de},
	number = {7},
	urldate = {2025-10-12},
	journal = {Zeitschrift für Gastroenterologie},
	author = {Götz, Martin and Biecker, Erwin and Dechêne, Alexander and Schilling, Dieter and Zipprich, Alexander and Trebicka, Jonel and Collaborators and Deutsche Gesellschaft für Gastroenterologie, Verdauungs-und Stoffwechselkrankheiten (DGVS) (federführend) and Vereinigung (DCCV), Deutsche Morbus Crohn und Colitis ulcerosa and Röntgengesellschaft (DRG), Deutsche and Radiologie (DeGiR), Deutsche Gesellschaft für interventionelle and Dgav, Deutsche Gesellschaft für Allgemein-und Viszeralchirurgie (DGAV) und Chirurgische Arbeitsgemeinschaft für Endoskopie und Sonografie (CAES) der and Intensivmedizin (DGIIN), Deutsche Gesellschaft für Internistische and Medizin (DGIM), Deutsche Gesellschaft für Innere and Kardiologie (DGK), Deutsche Gesellschaft für and Medizin (AEM), Akademie für Ethik in der and Hämostaseforschung (GTH), Gesellschaft für Thrombose und},
	month = jul,
	year = {2022},
	note = {Publisher: Georg Thieme Verlag KG},
	keywords = {Leitlinie},
	pages = {1139--1145},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\MFWDF265\\Götz et al. - 2022 - Addendum zur S2k-Leitlinie Gastrointestinale Blutungen der Deutschen Gesellschaft für Gastroenterolo.pdf:application/pdf},
}

@incollection{braun_intensivtherapie_2024,
	address = {Berlin, Heidelberg},
	title = {Intensivtherapie bei akuten gastrointestinalen {Blutungen}},
	isbn = {978-3-662-68699-7},
	url = {https://doi.org/10.1007/978-3-662-68699-7_75},
	abstract = {Man unterscheidet obere (OGIB), mittlere (MGIB) und untere gastrointestinale Blutungen (UGIB) voneinander. Akute gastrointestinale Blutungen manifestieren sich über frischblutiges Erbrechen (Hämatemesis), das Absetzen von Teerstuhl (Melaena) oder das Absetzen von frischem Blut mit oder ohne Blutkoagel (Hämatochezie). Bei oberen gastrointestinalen Blutungen müssen nicht variköse (NVOGIB, z. B. die Ulkusblutung) von varikösen Blutungen (VOGIB) unterschieden werden. Das alleinige kaffeesatzartige Erbrechen (Hämatinerbrechen) kann als ein Marker einer oberen gastrointestinalen Blutung geringerer Intensität gewertet werden. Für den Intensivmediziner steht bei der schweren akuten gastrointestinalen Blutung die initiale hämodynamische Stabilisierung vor dringlicher Endoskopie im Vordergrund.},
	language = {de},
	urldate = {2025-10-12},
	booktitle = {Die {Intensivmedizin}},
	publisher = {Springer},
	author = {Braun, Georg and Klebl, Frank and Messmann, Helmut},
	editor = {Marx, Gernot and Muhl, Elke and Zacharowski, Kai and Zeuzem, Stefan},
	year = {2024},
	doi = {10.1007/978-3-662-68699-7_75},
	pages = {1089--1096},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\S4SATK5F\\Braun et al. - 2024 - Intensivtherapie bei akuten gastrointestinalen Blutungen.pdf:application/pdf},
}

@article{koch_ursachen_2013,
	title = {Ursachen, patientenspezifische {Risikofaktoren} und prognostische {Indikatoren} bei akuter gastrointestinaler {Blutung} und intensivmedizinischer {Therapieindikation}},
	volume = {108},
	issn = {2193-6226},
	url = {https://doi.org/10.1007/s00063-013-0226-2},
	doi = {10.1007/s00063-013-0226-2},
	abstract = {Gastrointestinale Blutungen (GIB) stellen bei zunehmend älteren Patienten mit schweren Komorbiditäten und aggressiven thrombozytenhemmenden oder antikoagulatorischen Therapien ein häufiges Problem dar. Risikofaktoren und prognostische Indikatoren für schwere GIB, die eine intensivmedizinische Behandlung erfordern, sind unzureichend evaluiert.},
	language = {de},
	number = {3},
	urldate = {2025-10-12},
	journal = {Medizinische Klinik - Intensivmedizin und Notfallmedizin},
	author = {Koch, A. and Buendgens, L. and Dückers, H. and Bruensing, J. and Matthes, M. and Kunze, J. and Lutz, H.H. and Luedde, T. and Tischendorf, J.J.W. and Trautwein, C. and Tacke, F.},
	month = apr,
	year = {2013},
	keywords = {Endoscopy, Anticoagulation, Antikoagulation, Endoskopie, Lactate, Laktat, Prognose, Prognosis, Risikoassessment, Risk assessment},
	pages = {214--222},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\K3FLXWG2\\Koch et al. - 2013 - Ursachen, patientenspezifische Risikofaktoren und prognostische Indikatoren bei akuter gastrointesti.pdf:application/pdf},
}

@article{gottschalk_klassifikation_2021,
	title = {Klassifikation {Magenulkus} und {Magenblutung}},
	volume = {37},
	copyright = {Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany},
	issn = {0177-4077, 1611-6429},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/a-1253-5375},
	doi = {10.1055/a-1253-5375},
	abstract = {Thieme E-Books \& E-Journals},
	language = {de},
	number = {1},
	urldate = {2025-10-12},
	journal = {Endo-Praxis},
	author = {Gottschalk, Uwe and Maeting, Silvia and Jenssen, Christian},
	month = feb,
	year = {2021},
	note = {Publisher: Georg Thieme Verlag KG},
	keywords = {Weiterbildung},
	pages = {25--30},
}

@article{herrlinger_einteilung_2010,
	title = {Einteilung und {Management} der oberen gastrointestinalen {Blutung}},
	volume = {51},
	issn = {1432-1289},
	url = {https://doi.org/10.1007/s00108-010-2590-9},
	doi = {10.1007/s00108-010-2590-9},
	abstract = {Immer noch ist die obere gastrointestinale Blutung die häufigste Notfallsituation in der Gastroenterologie. Wegen der grundsätzlich verschiedenen Therapieansätze wird die Varizenblutung von der nicht-varikösen Blutung unterschieden. Essenziell sowohl für den Zeitpunkt der Endoskopie als auch zur Prognoseabschätzung ist die Risikoabschätzung bezüglich der Wahrscheinlichkeit einer Rezidivblutung, entsprechende Kriterien werden in dieser Arbeit diskutiert. Die modernen Therapieverfahren für beide Blutungssituationen werden mit ihren jeweiligen Erfolgsraten, aber auch Komplikationsrisiken dargestellt.},
	language = {de},
	number = {9},
	urldate = {2025-10-12},
	journal = {Der Internist},
	author = {Herrlinger, K.},
	month = sep,
	year = {2010},
	keywords = {Forrest classification, Forrest-Klassifikation, Nicht-variköse gastrointestinale Blutung, Non-variceal gastrointestinal bleeding, Sclerotherapy, Sklerosierungstherapie, Terlipressin, Variceal bleeding, Varizenblutung},
	pages = {1145--1158},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\GW2CHJSQ\\Herrlinger - 2010 - Einteilung und Management der oberen gastrointestinalen Blutung.pdf:application/pdf},
}

@incollection{klare_gastrointestinale_2022,
	address = {Berlin, Heidelberg},
	title = {Gastrointestinale {Blutung}},
	isbn = {978-3-662-64265-8},
	url = {https://doi.org/10.1007/978-3-662-64265-8_4},
	abstract = {Die gastrointestinale Blutung ist eine der wichtigsten Notfallsituationen im Dienstgeschäft der Inneren Medizin. Das klinische Bild ist dabei durchaus variabel und reicht von der milden Hämatochezie bis hin zur fulminanten Hämatemesis beim Kreislauf-instabilen Patienten. Jede Notfallsituation erfordert zunächst eine sorgfältige Ersteinschätzung hinsichtlich Schweregrad und möglicher Blutungsursache. Hiervon hängt nicht nur jede weitere Diagnostik und Therapie entscheiden ab, sie ermöglicht auch einen sinnvollen Einsatz von personellen und apparativen Ressourcen in der Nacht oder am Wochenende.},
	language = {de},
	urldate = {2025-10-12},
	booktitle = {Mein erster {Dienst} {Gastroenterologie}},
	publisher = {Springer},
	author = {Klare, Peter},
	editor = {Klare, Peter and Treese, Christoph and Würstle, Silvia},
	year = {2022},
	doi = {10.1007/978-3-662-64265-8_4},
	pages = {45--56},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\YIQMVBAQ\\Klare - 2022 - Gastrointestinale Blutung.pdf:application/pdf},
}

@article{malik_sop_2023,
	title = {{SOP} {Erstversorgung} bei einer gastrointestinalen {Blutung}},
	volume = {19},
	copyright = {Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany},
	issn = {1616-9670, 1616-9727},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/a-1935-0978},
	doi = {10.1055/a-1935-0978},
	abstract = {Eine gastrointestinale Blutung ist ein medizinischer Notfall, der rasch versorgt werden muss. Die schnelle Identifikation der Blutungsstelle sowie die Risikoeinschätzung stellen eine
          Herausforderung dar. Die Endoskopie ist dabei das Standardverfahren und wird folgend als SOP anhand eines Patientenfalls beleuchtet. Vorbereitende Maßnahmen zum endoskopischen Eingriff und
          die richtige Wahl der blutstillenden Methode sind ebenfalls Inhalt dieses Beitrags.},
	language = {de},
	number = {3},
	urldate = {2025-10-12},
	journal = {Gastroenterologie up2date},
	author = {Malik, Abaid and Khaleqi, Freba and Goetz, Martin},
	month = sep,
	year = {2023},
	note = {Publisher: Georg Thieme Verlag KG},
	keywords = {Antikoagulation, Blutung, gastrointestinal, Notfallendoskopie, Zeitpunkt},
	pages = {223--234},
}

@article{schweizer_therapie_2019,
	title = {Therapie der nichtvarikösen oberen gastrointestinalen {Blutung}: endoluminal – endovaskulär – chirurgisch},
	volume = {90},
	issn = {1433-0385},
	shorttitle = {Therapie der nichtvarikösen oberen gastrointestinalen {Blutung}},
	url = {https://doi.org/10.1007/s00104-019-0948-7},
	doi = {10.1007/s00104-019-0948-7},
	abstract = {Die nichtvariköse obere gastrointestinale Blutung (OGIB) hat eine hohe Letalität. Hämatemesis ggf. mit Meläna sind die Leitsymptome. Peptische Ulzerationen sind neben (erosiven) Entzündungen häufig, seltener sind das Mallory-Weiss-Syndrom, Neoplasien, Angiodysplasien und diffuse Blutungen.},
	language = {de},
	number = {8},
	urldate = {2025-10-12},
	journal = {Der Chirurg},
	author = {Schweizer, U. and Grund, K. E. and Fundel, J. and Wichmann, D. and Königsrainer, A.},
	month = aug,
	year = {2019},
	keywords = {Endoscopic diagnostics, Endoskopische Diagnostik, Endovascular treatment, Endovaskuläre Therapie, Intervention, Operation, Recurrent bleeding risk, Rezidivblutungsrisiko, Surgery},
	pages = {607--613},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\QRT48STQ\\Schweizer et al. - 2019 - Therapie der nichtvarikösen oberen gastrointestinalen Blutung endoluminal – endovaskulär – chirurgi.pdf:application/pdf},
}

@article{denzer_s2k-leitlinie_nodate,
	title = {S2k-{Leitlinie} {Qualitätsanforderungen} in der gastrointestinalen {Endoskopie} der {Deutschen} {Gesellschaft} für {Gastroenterologie}, {Verdauungs}- und {Stoffwechselkrankheiten} ({DGVS})},
	url = {https://www.dgvs.de/wp-content/uploads/2025/10/S2k-LL-Qualitaetsanforderungen-Endoskopie-v2.0_Langfassung_30.09.25.pdf},
	urldate = {2025-10-15},
	journal = {AWMF Register Nr. 021–022},
	author = {Denzer, Ulrike and Arlt, Alexander and Eickhoff, Axel and Rosien, Ulrich and Röth, Anjali A. and Jakobs, Ralf},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\2VAVEF46\\S2k-LL-Qualitaetsanforderungen-Endoskopie-v2.0_Langfassung_30.09.25.pdf:application/pdf},
}

@article{denzer_s2k_2015,
	title = {[{S2k} guideline: quality requirements for gastrointestinal endoscopy, {AWMF} registry no. 021-022]},
	volume = {53},
	issn = {1439-7803},
	shorttitle = {[{S2k} guideline},
	doi = {10.1055/s-0041-109598},
	language = {ger},
	number = {12},
	journal = {Zeitschrift Fur Gastroenterologie},
	author = {Denzer, U. and Beilenhoff, U. and Eickhoff, A. and Faiss, S. and Hüttl, P. and In der Smitten, S. and Jakobs, R. and Jenssen, C. and Keuchel, M. and Langer, F. and Lerch, M. M. and Lynen Jansen, P. and May, A. and Menningen, R. and Moog, G. and Rösch, T. and Rosien, U. and Vowinkel, T. and Wehrmann, T. and Weickert, U. and {Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten}},
	month = dec,
	year = {2015},
	pmid = {26783975},
	keywords = {Gastroenterology, Practice Guidelines as Topic, Conscious Sedation, Endoscopy, Gastrointestinal, Germany, Guideline Adherence, Registries},
	pages = {E1--227},
	file = {Volltext:C\:\\Users\\Tlux1\\Zotero\\storage\\M8SXSTKI\\Denzer et al. - 2015 - [S2k guideline quality requirements for gastrointestinal endoscopy, AWMF registry no. 021-022].pdf:application/pdf},
}

@article{praktiknjo_osophagusvarizenblutung_2022,
	title = {Ösophagusvarizenblutung: medikamentöse, endoskopische, interventionelle {Therapie}},
	volume = {18},
	copyright = {Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany},
	issn = {1616-9670, 1616-9727},
	shorttitle = {Ösophagusvarizenblutung},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/a-1729-2805},
	doi = {10.1055/a-1729-2805},
	abstract = {Die Varizenblutung ist durch ihre hohe Letalität eine der gefürchtetsten Komplikationen in der Gastroenterologie/Hepatologie. Das Management ist komplex und beinhaltet ein rasches und
					präzises Vorgehen bereits beim Eintreffen des Patienten. Dieser Beitrag beschreibt die State-of-the-Art-Therapie inklusive medikamentöser, endoskopischer und interventioneller Optionen sowie
					die aktuellen Empfehlungen zur Primär- und Sekundärprophylaxe.},
	language = {de},
	number = {2},
	urldate = {2025-10-15},
	journal = {Gastroenterologie up2date},
	author = {Praktiknjo, Michael and Trebicka, Jonel},
	month = jun,
	year = {2022},
	note = {Publisher: Georg Thieme Verlag KG},
	keywords = {Varizenblutung, endoskopische Blutstillung, TIPS, transjugulärer intrahepatischer portosystemischer Shunt, Zirrhose},
	pages = {135--148},
}

@article{blatchford_risk_2000,
	title = {A risk score to predict need for treatment for uppergastrointestinal haemorrhage},
	volume = {356},
	issn = {0140-6736, 1474-547X},
	url = {https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02816-6/abstract?/register/=111},
	doi = {10.1016/S0140-6736(00)02816-6},
	language = {English},
	number = {9238},
	urldate = {2025-10-15},
	journal = {The Lancet},
	author = {Blatchford, Oliver and Murray, William R. and Blatchford, Mary},
	month = oct,
	year = {2000},
	pmid = {11073021},
	note = {Publisher: Elsevier},
	pages = {1318--1321},
}

@article{bisschops_basic_2018,
	title = {{BASIC} ({BLI} {Adenoma} {Serrated} {International} {Classification}) classification for colorectal polyp characterization with blue light imaging},
	volume = {50},
	issn = {0013-726X, 1438-8812},
	url = {http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-121570},
	doi = {10.1055/s-0043-121570},
	abstract = {Background and study aim Advanced endoscopic imaging has revolutionized the characterization of lesions during colonoscopy. The aim of this study was to create a new classification for differentiating subcentimetric hyperplastic and adenomatous polyps, and deeply invasive malignant lesions using blue-light imaging (BLI) with high definition, with and without optical magnification, as well as to assess its interobserver concordance.},
	language = {en},
	number = {03},
	urldate = {2025-10-27},
	journal = {Endoscopy},
	author = {Bisschops, Raf and Hassan, Cesare and Bhandari, Pradeep and Coron, Emmanuel and Neumann, Helmut and Pech, Oliver and Correale, Loredana and Repici, Alessandro},
	month = mar,
	year = {2018},
	pages = {211--220},
	file = {PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\NMUVBBBP\\Bisschops et al. - 2018 - BASIC (BLI Adenoma Serrated International Classification) classification for colorectal polyp charac.pdf:application/pdf},
}

@article{gattrell_accord_2024,
	title = {{ACCORD} ({ACcurate} {COnsensus} {Reporting} {Document}): {A} reporting guideline for consensus methods in biomedicine developed via a modified {Delphi}},
	volume = {21},
	issn = {1549-1676},
	shorttitle = {{ACCORD} ({ACcurate} {COnsensus} {Reporting} {Document})},
	url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004326},
	doi = {10.1371/journal.pmed.1004326},
	abstract = {Background In biomedical research, it is often desirable to seek consensus among individuals who have differing perspectives and experience. This is important when evidence is emerging, inconsistent, limited, or absent. Even when research evidence is abundant, clinical recommendations, policy decisions, and priority-setting may still require agreement from multiple, sometimes ideologically opposed parties. Despite their prominence and influence on key decisions, consensus methods are often poorly reported. Our aim was to develop the first reporting guideline dedicated to and applicable to all consensus methods used in biomedical research regardless of the objective of the consensus process, called ACCORD (ACcurate COnsensus Reporting Document). Methods and findings We followed methodology recommended by the EQUATOR Network for the development of reporting guidelines: a systematic review was followed by a Delphi process and meetings to finalize the ACCORD checklist. The preliminary checklist was drawn from the systematic review of existing literature on the quality of reporting of consensus methods and suggestions from the Steering Committee. A Delphi panel (n = 72) was recruited with representation from 6 continents and a broad range of experience, including clinical, research, policy, and patient perspectives. The 3 rounds of the Delphi process were completed by 58, 54, and 51 panelists. The preliminary checklist of 56 items was refined to a final checklist of 35 items relating to the article title (n = 1), introduction (n = 3), methods (n = 21), results (n = 5), discussion (n = 2), and other information (n = 3). Conclusions The ACCORD checklist is the first reporting guideline applicable to all consensus-based studies. It will support authors in writing accurate, detailed manuscripts, thereby improving the completeness and transparency of reporting and providing readers with clarity regarding the methods used to reach agreement. Furthermore, the checklist will make the rigor of the consensus methods used to guide the recommendations clear for readers. Reporting consensus studies with greater clarity and transparency may enhance trust in the recommendations made by consensus panels.},
	language = {en},
	number = {1},
	urldate = {2025-10-29},
	journal = {PLOS Medicine},
	author = {Gattrell, William T. and Logullo, Patricia and Zuuren, Esther J. van and Price, Amy and Hughes, Ellen L. and Blazey, Paul and Winchester, Christopher C. and Tovey, David and Goldman, Keith and Hungin, Amrit Pali and Harrison, Niall},
	month = jan,
	year = {2024},
	note = {Publisher: Public Library of Science},
	keywords = {Drug research and development, Health care policy reports, Patient advocacy, Research reporting guidelines, Science policy, Surveys, Systematic reviews, Treatment guidelines},
	pages = {e1004326},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\X8U59M4Y\\Gattrell et al. - 2024 - ACCORD (ACcurate COnsensus Reporting Document) A reporting guideline for consensus methods in biome.pdf:application/pdf},
}

@misc{aronchick_validation_1999,
	title = {Validation of an instrument to assess colon cleansing},
	url = {https://cir.nii.ac.jp/crid/1370004235501603456},
	urldate = {2025-10-29},
	author = {Aronchick, CA},
	year = {1999},
	note = {Pages: 2667
Publication Title: Am. J. Gastroenterol.
Volume: 94},
	file = {Validation of an instrument to assess colon cleansing Snapshot:C\:\\Users\\Tlux1\\Zotero\\storage\\3LRAZYFV\\1370004235501603456.html:text/html},
}

@article{wendon_easl_2017,
	title = {{EASL} {Clinical} {Practical} {Guidelines} on the management of acute (fulminant) liver failure},
	volume = {66},
	issn = {0168-8278, 1600-0641},
	url = {https://www.journal-of-hepatology.eu/article/S0168-8278(16)30708-5/fulltext},
	doi = {10.1016/j.jhep.2016.12.003},
	language = {English},
	number = {5},
	urldate = {2025-10-30},
	journal = {Journal of Hepatology},
	author = {Wendon, Julia and Cordoba, Juan and Dhawan, Anil and Larsen, Fin Stolze and Manns, Michael and Nevens, Frederik and Samuel, Didier and Simpson, Kenneth J. and Yaron, Ilan and Bernardi, Mauro},
	month = may,
	year = {2017},
	pmid = {28417882},
	note = {Publisher: Elsevier},
	pages = {1047--1081},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\AJNB2CHZ\\Wendon et al. - 2017 - EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure.pdf:application/pdf},
}

@article{nielsen_impact_2017,
	title = {Impact of feedback and monitoring on colonoscopy withdrawal times and polyp detection rates},
	volume = {4},
	copyright = {This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license},
	issn = {2054-4774},
	url = {https://bmjopengastro.bmj.com/content/4/1/e000142},
	doi = {10.1136/bmjgast-2017-000142},
	abstract = {Background Previous studies have shown colonoscopy withdrawal time (WT) to be a reliable surrogate indicator for polyp detection rate (PDR) and adenoma detection rate (ADR) in colonoscopy. Our aim was to assess the impact of feedback and monitoring of WT on PDR in routine colonoscopies with long-term follow-up.Materials and methods A total of 307 colonoscopies were performed in three separate clinical scenarios. First, PDR and WT were recorded without the staff being aware of the specific objective of the study. Before the second scenario, the staff was given interventional information and feedback on WTs and PDRs from the first scenario and was encouraged to aim for a minimum WT of 8 min. Retention of knowledge gained was reassessed in the third scenario 1 year later.Results The PDR in the first two scenarios differed significantly (p{\textless}0.01), with a more than 90\% increase in PDR after intervention from 22\% to 42\% (95\% CI 1.44 to 4.95), although the mean WT did not change (6.8 vs 7.2 min; p{\textgreater}0.05). The increase in PDR between the first and second scenarios was retained in the third follow-up scenario 1 year later where the WT of both polyp-positive and polyp-negative colonoscopies was found to be longer.Conclusions PDR almost doubled from the first to the second scenario of a real-life colonoscopy setting, indicating that awareness of WT is crucial. The knowledge gained from this intervention in routine practice was even retained after a year.},
	language = {en},
	number = {1},
	urldate = {2025-10-31},
	journal = {BMJ Open Gastroenterology},
	author = {Nielsen, Amalie Bach and Nielsen, Ole Haagen and Hendel, Jakob},
	month = jun,
	year = {2017},
	pmid = {10.1136/bmjgast-2017-000142},
	note = {Publisher: BMJ Publishing Group Ltd},
	file = {Full Text PDF:C\:\\Users\\Tlux1\\Zotero\\storage\\LT2PFIGW\\Nielsen et al. - 2017 - Impact of feedback and monitoring on colonoscopy withdrawal times and polyp detection rates.pdf:application/pdf},
}

@article{sung_global_2021,
	title = {Global {Cancer} {Statistics} 2020: {GLOBOCAN} {Estimates} of {Incidence} and {Mortality} {Worldwide} for 36 {Cancers} in 185 {Countries}},
	volume = {71},
	issn = {0007-9235},
	shorttitle = {Global {Cancer} {Statistics} 2020},
	url = {https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21660},
	doi = {10.3322/caac.21660},
	abstract = {Abstract This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7\%), followed by lung (11.4\%), colorectal (10.0 \%), prostate (7.3\%), and stomach (5.6\%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18\%), followed by colorectal (9.4\%), liver (8.3\%), stomach (7.7\%), and female breast (6.9\%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied {\textless}2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47\% rise from 2020, with a larger increase in transitioning (64\% to 95\%) versus transitioned (32\% to 56\%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.},
	number = {3},
	urldate = {2025-11-16},
	journal = {CA: A Cancer Journal for Clinicians},
	author = {Sung, Hyuna and Ferlay, Jacques and Siegel, Rebecca L. and Laversanne, Mathieu and Soerjomataram, Isabelle and Jemal, Ahmedin and Bray, Freddie},
	month = may,
	year = {2021},
	note = {Publisher: American Cancer Society},
	keywords = {burden, cancer, epidemiology, incidence, mortality},
	pages = {209--249},
	file = {Volltext:C\:\\Users\\Tlux1\\Zotero\\storage\\C38VYNMV\\Sung et al. - 2021 - Global Cancer Statistics 2020 GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancer.pdf:application/pdf},
}

@article{shaukat_acg_2021,
	title = {{ACG} {Clinical} {Guidelines}: {Colorectal} {Cancer} {Screening} 2021},
	volume = {116},
	issn = {0002-9270},
	shorttitle = {{ACG} {Clinical} {Guidelines}},
	url = {https://journals.lww.com/ajg/fulltext/2021/03000/acg_clinical_guidelines__colorectal_cancer.14.aspx},
	doi = {10.14309/ajg.0000000000001122},
	abstract = {Colorectal cancer (CRC) is the third most common cancer in men and women in the United States. CRC screening efforts are directed toward removal of adenomas and sessile serrated lesions and detection of early-stage CRC. The purpose of this article is to update the 2009 American College of Gastroenterology CRC screening guidelines. The guideline is framed around several key questions. We conducted a comprehensive literature search to include studies through October 2020. The inclusion criteria were studies of any design with men and women age 40 years and older. Detailed recommendations for CRC screening in average-risk individuals and those with a family history of CRC are discussed. We also provide recommendations on the role of aspirin for chemoprevention, quality indicators for colonoscopy, approaches to organized CRC screening and improving adherence to CRC screening. CRC screening must be optimized to allow effective and sustained reduction of CRC incidence and mortality. This can be accomplished by achieving high rates of adherence, quality monitoring and improvement, following evidence-based guidelines, and removing barriers through the spectrum of care from noninvasive screening tests to screening and diagnostic colonoscopy. The development of cost-effective, highly accurate, noninvasive modalities associated with improved overall adherence to the screening process is also a desirable goal.},
	language = {en-US},
	number = {3},
	urldate = {2025-11-16},
	journal = {Official journal of the American College of Gastroenterology {\textbar} ACG},
	author = {Shaukat, Aasma and Kahi, Charles J. and Burke, Carol A. and Rabeneck, Linda and Sauer, Bryan G. and Rex, Douglas K.},
	month = mar,
	year = {2021},
	pages = {458},
	file = {Snapshot:C\:\\Users\\Tlux1\\Zotero\\storage\\NRW7LGGA\\acg_clinical_guidelines__colorectal_cancer.14.html:text/html},
}

@article{kumar_adenoma_2017,
	title = {Adenoma miss rates associated with a 3-minute versus 6-minute colonoscopy withdrawal time: a prospective, randomized trial},
	volume = {85},
	issn = {1097-6779},
	shorttitle = {Adenoma miss rates associated with a 3-minute versus 6-minute colonoscopy withdrawal time},
	doi = {10.1016/j.gie.2016.11.030},
	abstract = {BACKGROUND AND AIMS: The 6-minute withdrawal time for colonoscopy, widely considered the standard of care, is controversial. The skill and technique of endoscopists may be as important as, or more important than, withdrawal time for adenoma detection. It is unclear whether a shorter withdrawal time with good technique yields an acceptable lesion detection rate. Our objective was to evaluate a 3-minute versus a 6-minute withdrawal time by using segmental tandem colonoscopy.
METHODS: We performed a prospective, randomized trial by using 4 expert endoscopists. Patients were randomized to a 3-minute or a 6-minute initial withdrawal, each followed by a tandem second 6-minute withdrawal. All polyps were removed. The primary outcomes were adenoma miss rates (AMRs), adenomas per colonoscopy (APC) rates, and adenoma detection rates (ADRs).
RESULTS: A total of 99 and 101 patients were enrolled in the 3-minute and 6-minute withdrawal groups, respectively. The AMR was significantly higher in the 3-minute withdrawal group (48.0\% vs 22.9\%; P = .0001). After controlling for endoscopist, patient age and/or sex, Boston Bowel Preparation Scale score, and size and/or location and/or morphology of adenoma, the AMR remained significantly higher in the 3-minute withdrawal group (odds ratio, 2.78; 95\% confidence interval, 1.35-5.15; P = .0001). The ADR was similar between both groups (39.2\% vs 40.6\%; P = .84). However, the mean APC rate was significantly lower in the 3-minute withdrawal group (0.55 vs 0.80; P = .0001).
CONCLUSIONS: The AMR was significantly higher, and the APC rate was significantly lower in the 3-minute withdrawal group versus the 6-minute withdrawal group. Despite expert technique, a shorter withdrawal time is associated with an unacceptably high AMR and low APC rate. (Clinical trial registration number: NCT01802008.).},
	language = {eng},
	number = {6},
	journal = {Gastrointestinal Endoscopy},
	author = {Kumar, Sheila and Thosani, Nirav and Ladabaum, Uri and Friedland, Shai and Chen, Ann M. and Kochar, Rajan and Banerjee, Subhas},
	month = jun,
	year = {2017},
	pmid = {27931951},
	keywords = {Colonoscopy, Colorectal Neoplasms, Humans, Adenoma, Aged, Female, Male, Middle Aged, Diagnostic Errors, Odds Ratio, Operative Time, Prospective Studies},
	pages = {1273--1280},
}
