Artificial Intelligence in Digestive Endoscopy—Where Are We and Where Are We Going?

Abstract

Artificial intelligence, a computer-based concept that tries to mimic human thinking, is slowly becoming part of the endoscopy lab. It has developed considerably since the first attempt at developing an automated medical diagnostic tool, today being adopted in almost all medical fields, digestive endoscopy included. The detection rate of preneoplastic lesions (i.e., polyps) during colonoscopy may be increased with artificial intelligence assistance. It has also proven useful in detecting signs of ulcerative colitis activity. In upper digestive endoscopy, deep learning models may prove to be useful in the diagnosis and management of upper digestive tract diseases, such as gastroesophageal reflux disease, Barrett’s esophagus, and gastric cancer. As is the case with all new medical devices, there are challenges in the implementation in daily medical practice. The regulatory, economic, organizational culture, and language barriers between humans and machines are a few of them. Even so, many devices have been approved for use by their respective regulators. Future studies are currently striving to develop deep learning models that can replicate a growing amount of human brain activity. In conclusion, artificial intelligence may become an indispensable tool in digestive endoscopy.

The imitation game: a review of the use of artificial intelligence in colonoscopy, and endoscopists’ perceptions thereof

“…CADx involves characterizing polyps based on morphological parameters, such as surface, vascular patterns, shape, size, and location, to generate probability scores for malignancy or nonmalignancy [ 41 ]. This helps to improve the accuracy of optical biopsies, which refer to the in vivo prediction of polyp histology before resection and formal histological analysis [ 42 ].…”

Artificial intelligence and automation in endoscopy and surgery

“…Regulatory approval pathways are globally evolving but countries differ in their approach to regulation 136,137 . As of 2022, 13 AI devices have cleared regulatory approvals in Europe, China and Japan 138,139 . These AI devices are mainly dedicated to the detection of polyps in colonoscopy (e.g., Olympus ENDO-AID, Odin Vision CADDIE).…”

“…Together with the adaptation of regulatory approval procedures for AI-based medical devices, legal frameworks must be defined to address critical liability issues 139 and establish appropriate reimbursement schemes. Currently, the lack of evidence regarding AI-based devices costsaving prevents any refund charges by public health organizations or health insurance systems 142,143 .…”

Artificial intelligence in gastrointestinal endoscopy: a comprehensive review

“…As discussed by Vulpoi et al , DL models show promise in diagnosing and managing upper digestive tract diseases, including BE. They may also help diagnose and manage gastroesophageal reflux disease [ 19 ]. Furthermore, the establishment of AI models like YOLOv5l, as reported by Wang et al , is assisting in diagnosing esophageal squamous-cell carcinoma and precancerous lesions, thereby enhancing diagnostic accuracy and reducing missed cases, which can assist junior endoscopists in improving diagnosis [ 17 ].…”