Reply to Chen et al.

We would like to thank Chen et al. for their comments on our study [1]. The artificial intelligence (AI) system performed comparably to experienced endoscopists. Compared with larger trials that evaluated the same AI system (GI Genius; Medtronic, Minneapolis, Minnesota, USA), the adenoma detection rates (ADRs) of the computer-aided detection groups [2] [3] were similar to the ADR of the AI system in our study.

This study was conducted to compare the AI with experienced endoscopists, who served as the control group. It was not designed to evaluate the impact of the AI on the performance of individual endoscopists. Therefore, endoscopists were not divided into subgroups. We agree that for further evaluation, endoscopists should be divided into subgroups with larger sample sizes. As the endoscopy image was simultaneously displayed on two opposing monitors, endoscopists and AI had equal chances to detect a polyp on their monitor, regardless of the time operators needed for observation and manipulation. Transient detections of the AI were re-evaluated by endoscopists.

Observation time of endoscopists was not decreased due to the study design. As the monitors of the AI and the endoscopists simultaneously displayed the same endoscopy image, and as withdrawal was paused for resection, no advantages were given to the AI system. AI was not switched off for resection as this would have elongated the colonoscopy procedure without benefits. In addition, we did not take biopsies of all detections of the AI as this would have been of no benefit to the patient. Every detection of the AI was carefully re-evaluated by the endoscopists, whose decision was used as the criterion standard.

Publication History

Article published online:
27 January 2022

• References

• 1 Zippelius C, Alqahtani SA, Schedel J. et al. Diagnostic accuracy of a novel artificial intelligence system for adenoma detection in daily practice: a prospective nonrandomized comparative study. Endoscopy 2021;
• 2 Repici A, Spadaccini M, Antonelli G. et al. Artificial intelligence and colonoscopy experience: lessons from two randomised trials. Gut 2021;
• 3 Repici A, Badalamenti M, Maselli R. et al. Efficacy of real-time computer-aided detection of colorectal neoplasia in a randomized trial. Gastroenterology 2020; 159: 512-520