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BACKGROUND: Computer-aided detection (CADe) increases adenoma detection in colonoscopy, but its effectiveness in postpolypectomy surveillance remains uncertain. This study compared the adenoma detection rate (ADR) of CADe-assisted versus standard high definition colonoscopy during surveillance. METHODS: We conducted a population-based, randomized controlled trial in the Galician colorectal cancer screening program. Colonoscopy days were randomized in a 1 : 1 ratio to high definition colonoscopy with or without CADe. The primary end point was the ADR. Prespecified subgroup analyses evaluated endoscopist baseline performance (median ADR in the standard arm). Effect estimates are reported as adjusted risk ratios (aRRs) with 95%CI. RESULTS: Of 5309 randomized surveillance colonoscopies, 4824 surveillance colonoscopies were included in the final analysis (2469 standard; 2355 CADe-assisted) after exclusion of incomplete examinations. The ADR did not differ between the groups (57.4% vs. 58.8%; aRR 1.02, 95%CI 0.95-1.10). CADe increased ADR among low performing (ADR <54.5%) endoscopists (45.5% vs. 52.1%; aRR 1.15, 95%CI 1.01-1.30), but not among high performing endoscopists (65.9% vs. 63.5%; aRR 0.96, 95%CI 0.88-1.05). CONCLUSIONS: In a high performing screening program, CADe did not increase ADR in surveillance colonoscopy. Its benefit may be limited to lower performing endoscopists.