Abstract
Objective
Colorectal adenomas are precursors of colorectal cancer, and adenoma detection rate (ADR) is a key quality metric inversely associated with the risk of post-colonoscopy cancer. Technological advances, such as new colonoscope models, texture and color enhancement imaging (TXI), and computer-aided detection (CADe) systems, have been proposed to improve ADR. However, their relative contributions to ADR improvement remain unclear. This study aimed to identify the clinical and technological factors most strongly associated with increased ADR in routine colonoscopy practice.Methods
We retrospectively analyzed 28,459 consecutive colonoscopies performed at a single center between 2017 and 2025. Variables included patient demographics, colonoscopy indications, endoscopist performance, colonoscope type, TXI use and CADe use. Pan-colonic chromoendoscopy with indigo carmine was used routinely. Univariable and multivariable logistic regression analyses were performed to identify independent factors associated with adenoma detection.Results
Overall ADR was 49.3%. Univariable analysis showed that age, male sex, symptom evaluation or surveillance, high-performing endoscopists, new colonoscope type, TXI use and CADe use were associated with adenoma detection. Multivariable analysis identified age (odds ratio 1.044), male sex (1.580), symptom evaluation (1.315) and surveillance (1.193), high-performing endoscopists (1.424), new colonoscope type (1.110) and TXI use (1.201) as independent predictors of adenoma detection. CADe use was not independently associated with ADR. A subgroup analysis restricted to procedures performed using the X1 system yielded consistent results.Conclusions
This large-scale study indicates that colonoscope type, TXI and endoscopist performance are the primary contributors to ADR, whereas the independent effect of CADe remains inconclusive in routine clinical practice.