在结肠镜检查过程中，人工智能计算机辅助检测（CADe）可以提高腺瘤检出率（ADR）并减少腺瘤错过率，但可能会增加非肿瘤性息肉过度诊断和过度治疗的风险。本研究的目的是量化CADe的益处和危害。采用系统性综述和荟萃分析的方法（PROSPERO：CRD42022293181）。通过2023年2月的Medline、Embase和Scopus数据库进行检索。选取随机试验比较CADe辅助和标准结肠镜检查在息肉和癌症检测方面的效果。作为益处结果，提取ADR（具有≥1个腺瘤的患者比例）、每个结肠镜检查检测到的腺瘤数量、高级腺瘤（≥10 mm，具有高级别异型和绒毛组织学）、每个结肠镜检查检测到的切除病变数量以及腺瘤错过率。作为危害结果，提取了非肿瘤性病变的切除数和结肠镜检查时间。使用随机效应模型对每个结果进行汇总。利用GRADE（Grading of Recommendations Assessment, Development and Evaluation）框架评估证据的可靠性。纳入了21个随机试验共计18,232名患者。相较于标准结肠镜检查组，CADe组的ADR较高（44.0% 对 35.9%；相对风险1.24 [95% CI, 1.16 to 1.33]；证据可靠度低）, 对应着55%的相对误检率降低（风险比0.45 [CI, 0.35 to 0.58]；证据可靠度中等）。CADe组的非肿瘤性息肉切除量较标准组更多（0.52 对 0.34 个结肠镜检查；均差 [MD]0.18个切除病变[CI, 0.11 to 0.26 个切除病变]；证据可靠度低）。CADe仅使检查时间略微增加（MD 0.47 分钟 [CI, 0.23 to 0.72 分钟]；证据可靠度中等）。本综述主要关注与患者重要结果相关的替代指标。然而，大多数患者可能认为癌症发病率和癌症相关死亡是重要结果。CADe对这类患者重要结果的影响仍不清楚。在结肠镜检查中使用CADe以检测息肉可以增加腺瘤的检出率，但对高级腺瘤的检出率没有影响，同时增加了非肿瘤性息肉不必要的切除率。 本研究获得欧洲委员会2020年地平线计划玛丽居里个体资助。

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.To quantify the benefits and harms of CADe in randomized trials.Systematic review and meta-analysis. (PROSPERO: CRD42022293181).Medline, Embase, and Scopus databases through February 2023.Randomized trials comparing CADe-assisted with standard colonoscopy for polyp and cancer detection.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.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).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.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.European Commission Horizon 2020 Marie Skłodowska-Curie Individual Fellowship.