Artificial intelligence in GI endoscopy: stumbling blocks, gold standards and the role of endoscopy societies

Abstract

Artificial intelligence has been portrayed as a silver bullet for a number of challenges encountered in gastrointestinal (GI) endoscopy and beyond. Intense research, commercial and media focus have led to the publication of studies with modest patient numbers and comparatively simple technology. There is no doubt that machine learning (ML) will be a determining medical development for the years to come. However, now that the dust has begun to settle, we are at a critical juncture where the focus is shifting from preclinical work toward the role of ML in clinical practice. Current issues relate to the evaluation and testing of AI and ML systems, especially regarding patient outcomes, and to regulatory issues surrounding implementation. Many of these aspects pertain to one overarching question: how can we ensure that preclinical results translate into trustworthy clinical reality? For the endoscopist, whether as a reader, a reviewer or a potential user of AI, it becomes increasingly important to understand the technical aspects of the systems and their performance measurements in order to realistically assess their practical value. Therefore, with GI endoscopy ML at the jumpoff point from proofofprinciple studies to clinical trials, van der Sommen et al provided us with an accessible guide to understand, assess and critically review the current ML endoscopy literature. Our commentary highlights selected aspects of this review and AI as a whole and elaborates on the role of the GI endoscopy community and how it may both experience and frame the way ahead. In particular, we advocate a close collaboration of technology scientists and clinicians from early development phases onward to allow for the development of welltailored AI algorithms and realistic preclinical testing. More transparency is needed with respect to the training data and the algorithm development process. In addition, in the legislative debates, the endoscopy societies need to play a critical role in defining the research priorities, minimum standards and quality metrics by having a strong voice and presence in this field. Furthermore, we propose the establishment of a ‘rolling gold standard’ to meet requirements for continuous retesting and benchmarking of AI systems.