A 2025 meta-analysis of 46 randomized trials including 37,206 participants found that AI-assisted colonoscopy improved sessile serrated lesion detection rate (RR 1.25, 95% CI 1.12-1.40) and adenoma detection rate (RR 1.22, 95% CI 1.17-1.27) versus conventional colonoscopy. The study also showed fewer missed adenomas, although AI’s effect on sessile serrated lesion miss rate remained inconclusive.

Why It Matters To Your Practice

• Sessile serrated lesions are easy to miss and are clinically relevant precursors in Colorectal Cancer prevention.

• Across pooled RCT data, AI support increased both conventional adenoma detection and serrated lesion detection during routine colonoscopy.

• The signal is strongest for improving detection, not yet for proving fewer missed sessile serrated lesions.

Clinical Implications

• Expect AI tools to function primarily as real-time visual detection aids rather than replacements for withdrawal technique or mucosal exposure.

• Potential practice gains include higher adenoma detection rate, more lesions found per procedure, and lower adenoma miss rate.

• When evaluating vendors, clinicians should ask separately about performance for adenomas versus sessile serrated lesions.

Insights

• The review synthesized evidence from PubMed, Scopus, and Web of Science through May 6, 2025.

• Primary outcomes included ADR, adenomas per colonoscopy, SSLDR, SSLs per colonoscopy, adenoma miss rate, and SSL miss rate.

• Heterogeneity was modest for SSLDR (I² 11.08%) and higher for ADR (I² 60.49%), suggesting more consistency for the serrated lesion finding than for overall adenoma detection.

The Bottom Line

• AI-assisted colonoscopy appears ready to improve lesion detection in everyday practice, especially for adenomas and sessile serrated lesions.

• But clinicians should be cautious about overinterpreting benefit on sessile serrated lesion miss rate until stronger evidence emerges.