Colonoscopy has become one of the most effective tools in modern medicine for preventing colorectal cancer. By allowing doctors to identify and remove precancerous polyps before they develop into cancer, this procedure has helped reduce both incidence and mortality rates over the past several decades. Yet even with its proven track record, variability in polyp shape and size can lead to overlooked problems and delayed diagnosis. Fortunately the rapidly expanding capabilities of artificial intelligence are being integrated into colonoscopies in order to improve outcomes.

Colonoscopy: The Gold Standard for Colon Cancer Prevention

Colonoscopy has transformed colorectal cancer prevention since becoming widely adopted for screening decades ago. This procedure represents one of medicine’s clearest success stories in cancer prevention, directly contributing to a significant decline in both colorectal cancer incidence and death rates over the past three decades. The ability to both detect existing cancers at early stages and prevent future cancers by removing precancerous growths has made colonoscopy the preferred screening method recommended by major medical organizations.

During a colonoscopy, gastroenterologists use a thin, flexible instrument equipped with a high-definition camera to examine the entire colon and rectum. The primary target during this examination is polyps, small growths that develop on the inner lining of the colon and vary significantly in size, shape, and appearance. While most polyps remain harmless, certain types called adenomatous polyps have the potential to transform into cancer over time, typically taking 10 to 15 years to progress through this transformation.

The procedure’s effectiveness stems from its dual capability of detection and immediate treatment. When polyps are identified during the examination, they can often be removed on the spot using specialized instruments passed through the colonoscope, eliminating the need for separate surgical procedures. This immediate intervention prevents the natural progression from benign polyp to invasive cancer, which explains why regular colonoscopy screening can reduce colorectal cancer incidence by as much as 60% and mortality by as much as 70%.

Challenges in Polyp Detection

Despite colonoscopy’s proven effectiveness, it’s possible for polyps to be missed and therefore the detection of cancer be delayed. The human eye, even when guided by years of training and experience, must process a continuous stream of visual information while navigating through the colon’s complex anatomy. Research indicates that gastroenterologists can miss between 6% to 27% of adenomas during routine colonoscopy, with smaller polyps and those located in difficult-to-visualize areas being particularly susceptible to oversight.

Several factors contribute to these detection challenges. Polyps can vary dramatically in appearance, from raised, mushroom-like growths to flat lesions that blend subtly with the surrounding tissue. Some polyps hide behind folds in the colon wall or in areas where the scope’s angle makes visualization difficult. The procedure’s time constraints also play a role, as gastroenterologists must balance thorough examination with efficient patient flow, particularly in busy clinical settings.

The consequences of missed polyps extend beyond the immediate procedure. A polyp overlooked during one colonoscopy may grow larger or potentially progress toward malignancy before the next scheduled screening, which typically occurs 10 years later for average-risk patients. This detection gap represents one of the primary areas where technological assistance could significantly improve patient outcomes by providing a second set of “eyes” to help identify lesions that might otherwise go unnoticed.

How Artificial Intelligence Is Improving Colonoscopy Outcomes

This additional detection capability is now becoming a reality through artificial intelligence systems integrated into colonoscopy procedures. These AI tools work by analyzing the video feed from the colonoscope in real-time, using sophisticated algorithms trained on thousands of colonoscopy images to identify patterns that may indicate the presence of polyps or other abnormalities. When the system detects something suspicious, it can alert the physician immediately and therefore improve detection rates during the examination.1

  • Real-time polyp detection: AI systems continuously scan the video feed and highlight areas where polyps may be present, drawing the gastroenterologist’s attention to suspicious regions that might otherwise be overlooked. Studies show this can improve adenoma detection rates by 20-44% compared to standard colonoscopy.
  • Enhanced detection of flat and subtle lesions: AI excels at identifying the types of polyps that are most commonly missed by human observation, particularly flat lesions and those with subtle color variations that blend with surrounding tissue. These systems can detect changes in texture and morphology that may not be immediately apparent to the human eye.
  • Quality assessment monitoring: AI can evaluate important procedural factors such as bowel preparation adequacy and scope withdrawal speed, ensuring that conditions are optimal for thorough examination. Poor bowel preparation or rushed withdrawal times are known factors that contribute to missed polyps.
  • Reducing false positives: Advanced AI systems help distinguish between actual polyps and normal anatomical variations or debris, reducing unnecessary biopsies and improving procedural efficiency while maintaining high sensitivity for true abnormalities.2

AI Supports Gastrointestinal Expertise

While AI technology provides valuable detection support during colonoscopy, they are designed to enhance rather than replace the physician’s expertise. The gastroenterologist remains fully responsible for guiding the procedure, interpreting what is seen, and making treatment decisions. Just as doctors use other diagnostic tools like high-definition cameras or specialized lighting to enhance visualization, AI provides another layer of detection that helps confirm findings or draws attention to areas that warrant closer examination. The physician’s medical knowledge, clinical judgment, and years of specialized training remain essential for interpreting AI alerts, determining which findings require intervention, and developing appropriate treatment plans for each patient.

Contact Cary Gastro About Colorectal Cancer Screenings

Colorectal cancer remains the second leading cause of cancer deaths in the United States, yet it’s also one of the most preventable cancers when caught early through regular screening. The American Cancer Society now recommends that people at average risk begin colorectal cancer screening at age 45, while those with family history or other risk factors may need to start screening as early as age 40 or follow more frequent screening schedules. Regular colonoscopy screening can detect cancer in its earliest, most treatable stages and prevent cancer altogether by identifying and removing precancerous polyps.

At Cary Gastro, our gastroenterologists use advanced technology and evidence-based techniques to provide thorough colorectal cancer screening. Whether you’re approaching the age for your first screening or need to schedule follow-up care, our team can help determine the appropriate screening schedule based on your individual risk factors and medical history. Contact us today to request an appointment and discuss how regular screening can help protect your long-term health.




1https://www.sciencedirect.com/science/article/pii/S104314892400006X
2https://pmc.ncbi.nlm.nih.gov/articles/PMC12007662/