Artificial intelligence (AI)-assisted endoscopy

Key messages 

1. Evidence suggests that the use of AI-assisted lower GI endoscopy (colonoscopy) can improve the rates of detection and missed adenomas and polyps in people referred for screening, surveillance or symptomatic colonoscopy, but may slightly lengthen withdrawal time (time from reaching the cecum until removal of the endoscopy), compared with routine colonoscopy.
2. Use of AI-assisted lower GI colonoscopy may increase the number of non-neoplastic lesions removed during a procedure,2 but no other adverse events (AE) were reported from using AI.
3. An economic evaluation by Health Technology Wales (HTW) found that AI-assisted colonoscopy (computer-aided detection endoscopy) was cost-effective compared with standard colonoscopy. HTW estimated an incremental cost-effectiveness ratio (ICER) of £4,197 per quality adjusted life-year (QALY). The analysis was based on the lifetime costs and QALYs associated with the consequences of polyps being missed during standard colonoscopy that would not have been missed using computer-aided detection endoscopy. Any cost savings are likely to be realised over the long term.
4. A small focus group including staff and patients found that the benefits of AI-assisted lower GI colonoscopy were perceived as earlier identification and diagnosis of cancer, as well as reduced need for repeat procedures. Their concerns include the de-skilling of professionals, complacency and loss of human interaction.
5. Benefits of AI-assisted lower GI colonoscopy from the perspective of endoscopists include an improvement in adenoma detection rate (ADR), polyp detection rate (PDR) and quality of the procedure. Barriers to implementation include cost, accessibility and lack of guidelines.
6. The impact of AI-assisted lower GI colonoscopy on outcomes such as lower GI  cancer incidence and mortality, system changes, equality and sustainability is unclear. 
7. The effectiveness of different AI systems in unknown. 

Referred by

The Accelerated National Innovation Adoption (ANIA) pathway