Cost-effectiveness and environmental impact of artificial intelligence-assisted colonoscopy with the resect-and-discard strategy: a microsimulation study: GI Signals

Endoscopy retrospective · Aug 11, 2026 · Endoscopy · IF 11.8

Cost-effectiveness and environmental impact of artificial intelligence-assisted colonoscopy with the resect-and-discard strategy: a microsimulation study.

Guideline / reviewartificial intelligencecost-effectivenesscomputer-aided detectioncolorectal cancer screening

Clinical takeawayThis is a modeling study comparing strategy costs and outcomes, not a clinical trial of patient outcomes. It suggests that computer-aided detection improved adenoma detection without improving health outcomes compared to non-AI resect-and-discard; adding diagnostic AI (CADx) increased costs without clinical benefit. The findings suggest improved adenoma detection alone may not justify added costs and environmental impact if baseline health outcomes remain unchanged. However, these are model-based conclusions dependent on input assumptions about adenoma progression, detection accuracy, and mortality rates. Real-world adoption decisions about AI tools should consider actual performance, costs, and environmental impact in your setting. Individual gastroenterologists should not change current resect-and-discard practice based on this model.

What it foundIn a Markov model simulating 6 million individuals aged ≥45 years undergoing screening colonoscopy, non-AI resect-and-discard achieved the highest quality-adjusted life years (51.37 million) at lowest cost ($36.6B) and carbon emissions (0.90 million kg CO₂) compared to CADe-assisted RD ($36.9B) or CADe+CADx-assisted RD ($37.4B); differences in QALYs across strategies were <0.01%, and CADe modestly increased adenoma detection without improving health outcomes.

ContextCurrent practice widely promotes computer-aided detection (CADe) and diagnostic (CADx) tools to increase adenoma detection rates in screening colonoscopy. This model challenges the assumption that detection improvements alone drive health benefit in populations where screening is already reasonably effective, suggesting diminishing returns beyond baseline screening performance. The finding illustrates a general principle: increasing test performance does not always improve patient outcomes if the underlying disease is already well-managed with existing strategies.

Measured against the standard of care· USMSTF 2017 (Rex et al., Gastroenterology) + USMSTF 2022 focused update on age (Patel et al., Gastroenterology 2022;162:285-299) / ACS 2026 (CA Cancer J Clin)

Decision at stakeHow to manage diminutive polyps identified during screening colonoscopy

… Multi-Society Task Force (2017 guideline, revised by the 2022 focused update on age to start and stop): offer average-risk colorectal cancer screening to everyone aged 45-75. … Patients who are up to date with negative prior screening, particularly a high-quality colonoscopy, may consider stopping at 75 or when life expectancy is under 10 years. … The American Cancer Society's May 2026 guideline agrees on the 45-75 range, no screening after 85, and colonoscopy as the preferred option. …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

U.S. Multi-Society Task Force (2017 guideline, revised by the 2022 focused update on age to start and stop): offer average-risk colorectal cancer screening to everyone aged 45-75. Screening at 45-49 is a weaker recommendation than at 50-75. Colonoscopy every 10 years and annual FIT are the Tier 1 cornerstones. Tier 2 alternatives are multi-target stool DNA every 3 years, CT colonography every 5 years, and flexible sigmoidoscopy every 5-10 years. Capsule colonoscopy every 5 years is Tier 3. Any abnormal non-colonoscopy test requires a diagnostic colonoscopy, and a stool test should not be offered to a patient who would decline follow-up colonoscopy. Patients who are up to date with negative prior screening, particularly a high-quality colonoscopy, may consider stopping at 75 or when life expectancy is under 10 years. Decisions at 76-85 are individualized by health and prior screening, and screening after 85 is not recommended. The American Cancer Society's May 2026 guideline agrees on the 45-75 range, no screening after 85, and colonoscopy as the preferred option. It adds the next-generation mt-sDNA test and the multitarget stool RNA test (ColoSense), both every 3 years, and it adds an FDA-approved blood-based cfDNA test (Shield) only for people who decline or do not complete visual or stool screening. ACS says a positive stool or blood test should be followed by colonoscopy, preferably within 6 months. The 2026 ASGE paper on follow-up after an abnormal stool test is an implementation review (navigation, tracking, direct-access colonoscopy), not a new screening guideline.

USMSTF 2017 (Rex et al., Gastroenterology) + USMSTF 2022 focused update on age (Patel et al., Gastroenterology 2022;162:285-299) / ACS 2026 (CA Cancer J Clin) · reviewed 2026-10-11 ↗

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