Colonoscopy prevents colorectal cancer — but only when every lesion is found. Current miss rates for adenomas reach 26%, and for flat lesions, 34%. Sentinel Endo acts as an AI second observer that never fatigues, never looks away, and never misses a frame.
Colorectal cancer is the second leading cause of cancer death worldwide — and yet it is one of the most preventable cancers in existence. The adenoma-to-carcinoma sequence takes 10-15 years, giving clinicians an enormous window to find and remove precancerous polyps. The problem is not the biology. The problem is the variability in who is holding the scope. Adenoma detection rates among gastroenterologists range from 7% to 53% — a sevenfold difference that directly translates into cancer risk for patients.
Sentinel Endo eliminates this variability. It provides real-time, AI-powered polyp detection and characterization that raises every endoscopist to the performance level of the best — and raises the best to a level no human eye alone can achieve. It monitors colonoscopy quality metrics in real time, provides automated bowel preparation scoring, optimizes withdrawal technique, and generates comprehensive quality dashboards that drive continuous improvement across endoscopy units.
Sentinel Endo intervenes at every stage where detection and removal prevent cancer development.
Sentinel Endo transforms endoscopy from an operator-dependent art into a measurable, improvable, AI-augmented science.
The flagship engine. Sentinel Endo analyzes every frame of the colonoscopy video in real time, highlighting suspected polyps with a visual overlay on the endoscopy monitor. The system detects diminutive polyps (≤5mm), flat and sessile lesions, and serrated polyps that account for the majority of missed lesions. It acts as an always-alert second observer that never fatigues, never looks away during instrument exchanges, and maintains detection sensitivity regardless of procedure duration or time of day.
Once a polyp is detected, the critical question is: is it neoplastic? Sentinel Endo's CADx engine analyzes surface patterns, vascular architecture, and pit morphology to predict histology in real time — distinguishing adenomas from hyperplastic polyps, identifying sessile serrated lesions, and flagging advanced neoplasia. For diminutive polyps (≤5mm), this enables resect-and-discard or diagnose-and-leave strategies that reduce pathology costs while maintaining diagnostic accuracy.
Quality in colonoscopy is measurable — but rarely measured comprehensively. Sentinel Endo monitors every procedural quality indicator in real time: withdrawal time (≥6 minutes), mucosal exposure percentage, luminal distension adequacy, blind spot coverage (behind folds, near the ileocecal valve, at flexures), and inspection technique quality. The system generates a per-procedure quality score and identifies specific segments where inspection was inadequate — enabling the endoscopist to re-examine missed areas before completing the procedure.
The single most important quality metric in colonoscopy — adenoma detection rate — varies sevenfold across endoscopists. Sentinel Endo automatically tracks ADR, adenomas per colonoscopy (APC), sessile serrated lesion detection rate (SSLDR), cecal intubation rate, bowel preparation adequacy rate, and withdrawal time for every endoscopist. The system generates monthly performance dashboards, identifies trends, benchmarks against national standards, and flags endoscopists who fall below minimum thresholds — enabling targeted training and quality improvement.
Sentinel Endo extends AI detection to esophagogastroduodenoscopy (EGD). The system detects Barrett's esophagus and its dysplastic progression, early esophageal squamous cell carcinoma, gastric intestinal metaplasia, early gastric cancer, and celiac disease-associated villous atrophy. For Barrett's surveillance, the system guides systematic biopsy protocols and identifies areas of suspected dysplasia invisible to the naked eye — reducing the sampling error that allows dysplasia to progress to esophageal adenocarcinoma.
Bowel preparation quality is the single greatest determinant of colonoscopy effectiveness — yet it is graded subjectively and inconsistently. Sentinel Endo automatically scores bowel preparation using the Boston Bowel Preparation Scale (BBPS) with AI precision, segment by segment, in real time. The system identifies segments with inadequate preparation, recommends additional washing or suctioning, and documents preparation quality for the procedure report — ensuring standardized, auditable, and objective quality reporting.
The withdrawal phase of colonoscopy is where polyps are found — and where quality most varies. Sentinel Endo monitors withdrawal speed in real time, alerts when the endoscopist is moving too quickly through segments, identifies areas behind folds that have not been adequately inspected, and provides segment-by-segment coverage maps that ensure the entire mucosal surface has been visualized. The system provides subtle real-time coaching — slow-down alerts, reinspection prompts, and coverage completion indicators — that improve technique without disrupting workflow.
Sentinel Endo extends beyond individual procedures to population-level screening intelligence. The system tracks FIT-positive follow-up rates, screening colonoscopy completion rates, surveillance interval compliance, and interval cancer rates across the entire patient population. It identifies patients overdue for surveillance, flags high-risk individuals who have not completed recommended follow-up, and generates population health dashboards that demonstrate the cancer prevention impact of the endoscopy program to health system leadership, payers, and public health authorities.
Results from our deployed endoscopy programs.
Sentinel Endo was deployed across 14 endoscopists performing 8,000 colonoscopies annually. The practice's mean ADR rose from 32% to 48%. The lowest-performing endoscopist's ADR rose from 18% to 38%. The system detected 1,240 additional adenomas in the first year that would have been missed — each one a cancer prevented. ADR variability across the group dropped 48%, effectively standardizing quality across the entire practice.
A community hospital deployed Sentinel Endo's full quality suite — CADe, bowel preparation scoring, withdrawal optimization, and population screening intelligence. Over three years, the hospital's interval cancer rate dropped from 4.2% to 1.8%. Surveillance interval compliance improved 34%. The hospital's CRC screening program was recognized as a national benchmark, and the GI division's quality metrics became a competitive differentiator for the health system.
The CADx optical diagnosis engine was deployed across 6 ambulatory surgery centers performing 22,000 colonoscopies annually. For diminutive polyps (≤5mm), the resect-and-discard strategy guided by AI optical diagnosis reduced pathology submissions by 42% while maintaining diagnostic concordance with histopathology above 90%. Annual pathology cost savings exceeded $1.2M across the group — while simultaneously improving ADR through the companion CADe system.
I have performed over twelve thousand colonoscopies in my career. I considered myself a high-ADR endoscopist. Then Sentinel Endo showed me what I was missing. In my first month with the system, it detected 14 polyps I would have missed — including two sessile serrated lesions behind hepatic flexure folds. Two potential cancers. In one month. I will never scope without it again.
The quality dashboard transformed our group. We went from anecdotal quality assessment — "I think I'm a good endoscopist" — to objective, data-driven performance management. Two of our physicians were below the ADR minimum benchmark and didn't know it. With targeted feedback and AI-assisted detection, both are now above the 30% threshold. That is patient safety through measurement.
The resect-and-discard capability alone justified the investment. We were sending 8,000 diminutive polyps to pathology annually at $180 each — $1.4 million in pathology costs for lesions that were overwhelmingly benign. The AI optical diagnosis engine reduced submissions by 42% in the first year with concordance rates above 90%. The savings funded the entire platform with surplus.
Schedule a clinical demonstration of Sentinel Endo — configured for your endoscopy suite, your team, and your quality goals.