{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:23:41Z","timestamp":1790252621616,"version":"4.1.0"},"reference-count":23,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Artificial intelligence (AI)-assisted colonoscopy reduces costs in colorectal cancer screening, but its incremental value relative to non-AI resect-and-discard strategies for diminutive polyps (\u22645 mm) remains unclear. We aimed to compare the clinical, economic, and environmental outcomes of resect-and-discard strategies both with and without AI assistance with the standard of care (SoC).<\/jats:p>\n                  <jats:p>In our Markov model simulating 6 million individuals aged \u226545 years undergoing screening colonoscopy, four strategies were evaluated: SoC; non-AI resect and discard (nonAI-RD); computer-aided detection (CADe)-assisted resect and discard (CADe-RD); and combined CADe and computer-aided diagnosis (CADx)-assisted resect and discard (CADe+CADx-RD). The primary outcome was total quality-adjusted life years (QALYs), with secondary outcomes including cost and carbon dioxide (CO2) emissions.<\/jats:p>\n                  <jats:p>NonAI-RD achieved the lowest total cost ($36.6 billion) and carbon emissions (0.90 million kgCO2while yielding the highest QALYs (51.37 million), although differences in QALYs across strategies were small (&lt;0.01%). CADe-RD and CADe+CADx-RD remained cost-saving relative to SoC ($36.9 billion and $37.4 billion vs. $37.8 billion, respectively), but were associated with higher costs than nonAI-RD. CADe modestly increased adenoma detection without improving QALYs, while the addition of CADx increased costs and emissions and resulted in slightly lower QALYs. Sensitivity analysis showed that CADe+CADx-RD matched or exceeded the QALYs for CADe-RD only within a limited region of high diagnostic performance. At currently reported CADx performance levels, CADe+CADx-RD yielded lower QALYs and higher costs than CADe-RD. CADe+CADx-RD achieved noninferiority in QALYs relative to CADe-RD only within a limited region of high diagnostic performance.<\/jats:p>\n                  <jats:p>In our nondeterministic model, nonAI-RD provided the optimal balance of clinical benefit, cost savings, and lower environmental impact.<\/jats:p>","DOI":"10.1055\/a-2936-0598","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:41:31Z","timestamp":1786495291000},"source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness and environmental impact of artificial intelligence-assisted colonoscopy with the resect-and-discard strategy: a microsimulation study"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2117-9735","authenticated-orcid":false,"given":"Lyndon V.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"GI Associates, LLC, Wisconsin, United States","place":["Kenosha"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6446-5785","authenticated-orcid":false,"given":"Michael B.","family":"Wallace","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Florida, United States","place":["Jacksonville"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6125-0068","authenticated-orcid":false,"given":"Daniel","family":"von Renteln","sequence":"additional","affiliation":[{"name":"Centre hospitalier de l'universit\u00e9 de Montr\u00e9al, Canada","place":["Montreal"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jodi","family":"Sherman","sequence":"additional","affiliation":[{"name":"Yale University, Connecticut, United States","place":["New Haven"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1489-5947","authenticated-orcid":false,"given":"Manoop S.","family":"Bhutani","sequence":"additional","affiliation":[{"name":"University of Texas MD Anderson Cancer Center, Texas, United States","place":["Houston"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalini M.","family":"Guda","sequence":"additional","affiliation":[{"name":"GI Associates, LLC, Wisconsin, United States","place":["Milwaukee"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendell","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Pablo Torre Memorial Hospital, Philippines","place":["Bacolod City"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Klyve","sequence":"additional","affiliation":[{"name":"Central Washington University, Washington, United States","place":["Ellensburg"],"department":["Mathematics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo","family":"Manahan","sequence":"additional","affiliation":[{"name":"Atlantic Health, New Jersey, United States","place":["Morristown"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiko","family":"Pohl","sequence":"additional","affiliation":[{"name":"Dartmouth-Hitchcock Medical Center, Vermont, United States","place":["White River Junction"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1053\/j.gastro.2012.06.001","article-title":"Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer","volume":"143","author":"DA Lieberman","year":"2012","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1055\/s-0030-1256381","article-title":"A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps","volume":"43","author":"WR Kessler","year":"2011","journal-title":"Endoscopy"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1093\/ajcp\/aqab021","article-title":"Life cycle greenhouse gas emissions of gastrointestinal biopsies in a surgical pathology laboratory","volume":"156","author":"IO Gordon","year":"2021","journal-title":"Am J Clin Pathol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/j.gie.2022.08.002","article-title":"It's not lack of evidence holding back resect and discard","volume":"96","author":"DK Rex","year":"2022","journal-title":"Gastrointest Endosc"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.gie.2022.06.019","article-title":"Implementation of optical diagnosis with a \u201cresect and discard\u201d strategy in clinical practice: DISCARD3 study","volume":"96","author":"A Ahmad","year":"2022","journal-title":"Gastrointest Endosc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1016\/S2468-1253(24)00222-X","article-title":"Computer-aided diagnosis for the resect-and-discard strategy for colorectal polyps: a systematic review and meta-analysis","volume":"9","author":"C Hassan","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1055\/a-2717-8365","article-title":"Environmental impact of computer-aided diagnosis in colonoscopy: a carbon footprint assessment of a prospective study cohort","volume":"58","author":"O Olabintan","year":"2026","journal-title":"Endoscopy"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1136\/gutjnl-2018-317500","article-title":"Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates: a prospective randomised controlled study","volume":"68","author":"P Wang","year":"2019","journal-title":"Gut"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.7326\/M22-3678","article-title":"Real-time computer-aided detection of colorectal neoplasia during colonoscopy: a systematic review and meta-analysis","volume":"176","author":"C Hassan","year":"2023","journal-title":"Ann Intern Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1002\/ueg2.12285","article-title":"Endoscopists performance in optical diagnosis of colorectal polyps in artificial intelligence studies","volume":"10","author":"S Pecere","year":"2022","journal-title":"United European Gastroenterol J"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1053\/j.gastro.2008.06.083","article-title":"Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography","volume":"135","author":"D Lieberman","year":"2008","journal-title":"Gastroenterology"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.gie.2023.11.014","article-title":"Endoscopist adenomas-per-colonoscopy detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry","volume":"99","author":"JC Anderson","year":"2024","journal-title":"Gastrointest Endosc"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"303","DOI":"10.7326\/M22-1008","article-title":"Adenoma detection rate and colorectal cancer risk in fecal immunochemical test screening programs: an observational cohort study","volume":"176","author":"M Zorzi","year":"2023","journal-title":"Ann Intern Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1053\/j.gastro.2019.10.026","article-title":"Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer","volume":"115","author":"S GuptaSLiebermanDAnderson","year":"2020","journal-title":"Am J Gastroenterol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1093\/jncimonographs\/lgz032","article-title":"Cancer-attributable medical costs for colorectal cancer patients by phases of care: what is the effect of a prior cancer history?","volume":"2020","author":"AB Mariotto","year":"2020","journal-title":"J Natl Cancer Inst Monogr"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.gie.2020.03.3759","article-title":"Cost savings in colonoscopy with artificial intelligence-aided polyp diagnosis: an add-on analysis of a clinical trial (with video)","volume":"92","author":"Y Mori","year":"2020","journal-title":"Gastrointest Endosc"},{"key":"ref17","first-page":"C6","article-title":"Leaving colorectal polyps in situ with endocytoscopy assisted by computer-aided diagnosis: a cost-effectiveness study. Endoscopy 2025; 57: 611\u2013619","volume":"57","author":"N Halvorsen","year":"2025","journal-title":"Erratum in: Endoscopy"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1093\/jcag\/gwad014","article-title":"Cost-effectiveness of artificial intelligence-aided colonoscopy for adenoma detection in colon cancer screening","volume":"6","author":"AN Barkun","year":"2023","journal-title":"J Can Assoc Gastroenterol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1111\/den.15047","article-title":"Computer-aided diagnosis for colorectal polyp in comparison with endoscopists: Systematic review and meta-analysis","volume":"37","author":"S Shinozaki","year":"2025","journal-title":"Dig Endosc"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/j.mcpdig.2024.10.002","article-title":"Real-world assessment of the efficacy of computer-assisted diagnosis in colonoscopy: a single institution cohort study in Singapore","volume":"2","author":"GE Koh","year":"2024","journal-title":"Mayo Clin Proc Digit Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1016\/j.gie.2016.12.014","article-title":"Natural history of diminutive and small colorectal polyps: a systematic literature review","volume":"85","author":"JLA Vleugels","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1053\/j.gastro.2024.08.037","article-title":"Pragmatic resect and discard implementation using computer-assisted optical polyp diagnosis","volume":"168","author":"M Taghiakbari","year":"2025","journal-title":"Gastroenterology"},{"key":"ref23","first-page":"eP072","article-title":"eP072 Evaluation of the performance of a \u201cresect and discard\u201d strategy for diminutive colon polyps","volume":"57","author":"A Protopapas","year":"2025","journal-title":"Endoscopy"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2936-0598.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:23:54Z","timestamp":1790205834000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2936-0598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":23,"URL":"https:\/\/doi.org\/10.1055\/a-2936-0598","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8,11]]},"published":{"date-parts":[[2026,8,11]]}}}