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Before and after the interactive training or self-driven training, all trainees were given a QR code with 20 selected cases of colorectal polyp under BLI for testing. To decrease investigator bias, the investigators who were in charge of the research design were forbidden to be the test scorers. For control measures, the test scorers were blinded to the randomization. The trainees reviewed these images and made a diagnosis by entering the judgement of the NICE classification, the color, the vessel pattern, the surface pattern, and confidence in diagnosis (low or high). All the images were retrieved during standard care without any interventions or exposure of the patient’ personal information. These images of polyps were obtained using high-definition colonoscopes (EC-L590ZW, EC-L590ZP, EC-760ZP-V/M; Fujifilm Co). The polyps in the collected images in the before-training tests and the after-training tests had been resected and evaluated by pathology for histology confirmation.

The study used all 41 colonoscopies performed by expert Endoscopist A (Y.M.), who is a Board Certified Fellow and Trainer of the Japan Gastroenterological Endoscopy Society at Tokyo Women’s Medical University from 1 June to 30 July 2022, using a high-definition colonoscope (EC-760ZP-V/M, FUJIFILM Medical, Tokyo, Japan) and a high-definition monitor (CuratOR EX2621, EIZO Corporation, Hakusan, Japan). To avoid selection bias, we did not examine the symptoms, purpose of being examined, age, or sex of any of the patients. Referring to the previous report [16 (link)], the inclusion criteria were the presence of at least one neoplastic lesion (adenoma or adenocarcinoma) measuring < 10 mm. For the final determination of whether the lesion was neoplastic, the gold standard was CAD EYE’s CADx diagnosis. Patients with poor pretreatment (0 or 1 in any segment on the Boston Bowel Preparation Scale), with ≥5 neoplastic lesions, with inflammatory bowel disease, with polyposis, who underwent endoscopic procedures that included biopsies, and whose examination took ≥20 min were excluded. Finally, 21 patients with 34 lesions were included (Figure 2).