Background/Aims <p>This study aimed to investigate whether a real-time artificial intelligence (AI)-assisted polyp detection system can improve adenoma detection rates (ADRs) in real-world colonoscopy practice.</p> Methods <p>This single-center, retrospective, propensity score-matched study collected data from consecutive patients who underwent colonoscopy—either AI-assisted or standard colonoscopy— between March 2023 and February 2024. Propensity score matching was conducted to adjust for baseline characteristics across the groups.</p> Results <p>During the study period, 1,085 patients who underwent colonoscopy were eligible for inclusion. After propensity score matching, 474 patients who underwent AI-assisted colonoscopy and 474 who underwent standard colonoscopy were included in the primary analysis. The ADR was significantly higher in the AI-assisted colonoscopy group than in the standard colonoscopy group (35.9% vs. 26.4%; <i>p</i> = 0.002). Additionally, the number of adenomas detected per colonoscopy was significantly higher in the AI-assisted group than in the standard group (0.69 ± 1.22 vs. 0.43 ± 0.91; <i>p</i> &lt; 0.001). However, the detection rates of advanced adenomas and sessile serrated lesions did not differ significantly between the two groups.</p> Conclusion <p>AI-assisted colonoscopy significantly improves ADRs in real-world colonoscopy practice.</p>