Beyond White-Light Colonoscopy: Water Exchange, Image-Enhanced Endoscopy, and Artificial Intelligence for Colorectal Neoplasia Detection—From Single Tools to Combined Strategies: A Scoping Review
- 1Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- 2Gastroenterology Department, University Emergency Hospital of Bucharest, 020021 Bucharest, Romania
Abstract
Background: Water exchange, image-enhanced endoscopy (IEE), and computer-aided detection (CADe) address different reasons why colorectal lesions may be missed. Whether their benefits add up when the techniques are combined remains unclear. Objective: We mapped clinical and video-based evidence on combinations of these techniques for colorectal neoplasia detection. Methods: We conducted a scoping review following JBI methodology and PRISMA-ScR, with a protocol registered on the Open Science Framework. We searched PubMed, Web of Science, Scopus, ClinicalTrials.gov, and reference lists through September 2026. Eligible studies evaluated at least two techniques together in adults and reported a detection outcome. Large language model tools assisted screening, with reviewer verification. We summarized findings descriptively and added a structured, domain-based critical appraisal during revision. Results: From 644 database records, we included 18 studies: 13 patient-level clinical studies, nine randomized, and five lesion- or video-level studies. Most examined IEE with CADe. One trial directly added CADe to water exchange; one tested all three technique groups. No included clinical study used water immersion. Randomized incremental comparisons showed inconsistent adenoma detection rate (ADR) gains, while multicomponent trials could not isolate component effects. Historical controls, discretionary technique selection, selected video material, and incomplete reporting constrained other comparisons. Evidence on advanced and serrated lesions, procedural burden, and patient-important outcomes was limited. Conclusions: Combined strategies improved detection in some settings, but comparative effectiveness and net clinical benefit remain uncertain. Trials should isolate component effects and measure clinically relevant detection alongside procedural burden.
Related
- Effectiveness of artificial intelligence-assisted colonoscopy for colorectal lesion detection: a systematic review and meta-analysis of randomized controlled trials
- Artificial Intelligence‐Optimized Image Biomarker Identification for Sinonasal Inverted Papilloma Diagnosis Using Image‐Enhanced Versus White‐Light Endoscopy
- Follow-up colonoscopy after abnormal stool-based colorectal cancer screening: a systematic review of completion, timeliness and implementation strategies
- Learning and deskilling effects of artificial intelligence in colonoscopy among endoscopists with different levels of experience: a pragmatic, prospective trial
- Artificial Intelligence Versus Conventional Scoring for Assessing Small Bowel Capsule Endoscopy Cleanliness in Crohn's Disease
BibTeX
@article{spataru2026beyond,
title = {{Beyond White-Light Colonoscopy: Water Exchange, Image-Enhanced Endoscopy, and Artificial Intelligence for Colorectal Neoplasia Detection—From Single Tools to Combined Strategies: A Scoping Review}},
author = {Teodora Spataru and Remus Popescu and Alina Pistritu and Marina Cozma and Lucian Negreanu},
journal = {Cancers},
year = {2026},
month = nov,
doi = {10.3390/cancers18213553},
url = {https://www.mdpi.com/2072-6694/18/21/3553},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Beyond White-Light Colonoscopy: Water Exchange, Image-Enhanced Endoscopy, and Artificial Intelligence for Colorectal Neoplasia Detection—From Single Tools to Combined Strategies: A Scoping Review
AU - Teodora Spataru
AU - Remus Popescu
AU - Alina Pistritu
AU - Marina Cozma
AU - Lucian Negreanu
PY - 2026
DA - 2026/11/05
JO - Cancers
DO - 10.3390/cancers18213553
UR - https://www.mdpi.com/2072-6694/18/21/3553
AB - Background: Water exchange, image-enhanced endoscopy (IEE), and computer-aided detection (CADe) address different reasons why colorectal lesions may be missed. Whether their benefits add up when the techniques are combined remains unclear. Objective: We mapped clinical and video-based evidence on combinations of these techniques for colorectal neoplasia detection. Methods: We conducted a scoping review following JBI methodology and PRISMA-ScR, with a protocol registered on the Open Science Framework. We searched PubMed, Web of Science, Scopus, ClinicalTrials.gov, and reference lists through September 2026. Eligible studies evaluated at least two techniques together in adults and reported a detection outcome. Large language model tools assisted screening, with reviewer verification. We summarized findings descriptively and added a structured, domain-based critical appraisal during revision. Results: From 644 database records, we included 18 studies: 13 patient-level clinical studies, nine randomized, and five lesion- or video-level studies. Most examined IEE with CADe. One trial directly added CADe to water exchange; one tested all three technique groups. No included clinical study used water immersion. Randomized incremental comparisons showed inconsistent adenoma detection rate (ADR) gains, while multicomponent trials could not isolate component effects. Historical controls, discretionary technique selection, selected video material, and incomplete reporting constrained other comparisons. Evidence on advanced and serrated lesions, procedural burden, and patient-important outcomes was limited. Conclusions: Combined strategies improved detection in some settings, but comparative effectiveness and net clinical benefit remain uncertain. Trials should isolate component effects and measure clinically relevant detection alongside procedural burden.
SN - 2072-6694
ER -