Artificial Intelligence–Assisted Optical Diagnosis: A Comprehensive Review of Its Role in Leave-In-Situ and Resect-and-Discard Strategies in Colonoscopy

Abstract

Colorectal cancer (CRC) screening plays a vital role in early detection and removal of precancerous adenomas, contributing to decreased mortality rates. The majority of polyps found during colonoscopies are small and unlikely to harbor advanced neoplasia or invasive cancer, leading to the development of 'leave-in-situ' and 'resect and discard' approaches. These strategies could lead to significant cost savings and efficiencies, but their implementation has been hampered by concerns around financial incentives, medical-legal risks, and local rules for tissue handling. This article reviews the potential of artificial intelligence (AI) to enhance the accuracy of polyp diagnosis via Computer-aided diagnosis (CADx). While the adoption of CADx in optical biopsy has shown mixed results, it has the potential to significantly improve the management of colorectal polyps. Several studies reviewed in the article highlight the varied results of CADx in optical biopsy for colorectal polyps. While AI doesn't consistently outperform expert endoscopists, It has the potential to serve as a beneficial secondary reader, aiding in accurate optical diagnosis and increasing the confidence of the endoscopist. These studies indicate that while CADx holds great potential, it is yet to fully meet the performance thresholds necessary for clinical implementation.

“I Wonder if my Years of Training and Expertise Will be Devalued by Machines”: Concerns About the Replacement of Medical Professionals by Artificial Intelligence

“…However, their concerns about diagnostic accuracy resonate with existing research that emphasizes the importance of AI's accuracy and safety in patient care ( Lång et al, 2023 ). Ensuring that AI's diagnostic capabilities align with the highest standards is crucial to prevent unnecessary stress or missed diagnoses for patients ( El Zoghbi et al, 2023 ). The strategies to enhance patient care through AI integration reflect a growing consensus that AI can streamline routine tasks, allowing healthcare professionals to focus on personalized, patient-centered care ( Osama et al, 2023 ; Zarella et al, 2023 ).…”

The Use of Artificial Intelligence in Gastroenterology: A Glimpse Into the Present

“…When I think about AI, I am struck by its potential to enhance both the care we deliver and the additional time we may save while providing that care. In this special issue, you'll find examples of how AI may be able to improve diagnostic accuracy, whether it's computer-aided diagnosis of in situ colon polyps ( 1 ), real-time detection of Helicobacter pylori infection ( 2 ), or determining the invasion depth of esophageal squamous cell carcinoma ( 3 ). AI can also improve patient access to GI diagnostics, as some technologies may become more easily utilized by primary care providers or allied health professionals.…”