Benefits and challenges in implementation of artificial intelligence in colonoscopy: World Endoscopy Organization position statement

Yuichi Mori^{1

2

3}, James E East^{4

5

6}, Cesare Hassan^{7

8}, Natalie Halvorsen¹, Tyler M Berzin⁹, Michael Byrne¹⁰, Daniel von Renteln¹¹, David G Hewett¹², Alessandro Repici^{7

8}, Mohan Ramchandani¹³, Maryam Al Khatry¹⁴, Shin-Ei Kudo³, Pu Wang¹⁵, Honggang Yu¹⁶, Yutaka Saito¹⁷, Masashi Misawa³, Sravanthi Parasa¹⁸, Carolina Ogawa Matsubayashi¹⁹, Haruhiko Ogata²⁰, Hisao Tajiri²¹, Nonthalee Pausawasdi^{22

23}, Evelien Dekker²⁴, Omer F Ahmad²⁵, Prateek Sharma²⁶, Douglas K Rex²⁷

Affiliations

¹ Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.
² Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
³ Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
⁴ Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK.
⁵ NIHR Oxford Biomedical Research Centre, Oxford, UK.
⁶ Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK.
⁷ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
⁸ Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.
⁹ Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
¹⁰ Department of Medicine, The University of British Columbia, Vancouver, Canada.
¹¹ Division of Gastroenterology, University of Montreal Medical Center (CHUM) and Research Center (CRCHUM), Montreal, Canada.
¹² School of Medicine, The University of Queensland, Brisbane, Australia.
¹³ Asian Institute of Gastroenterology, Hyderabad, India.
¹⁴ Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, United Arab Emirates.
¹⁵ Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
¹⁶ Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.
¹⁷ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
¹⁸ Swedish Medical Center, Seattle, USA.
¹⁹ Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
²⁰ Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
²¹ Jikei University School of Medicine, Tokyo, Japan.
²² Vikit Viranuvatti Siriraj GI Endoscopy Center, Mahidol University, Bangkok, Thailand.
²³ Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁴ Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
²⁵ University College London, London, UK.
²⁶ Division of Gastroenterology and Hepatology, University of Kansas School of Medicine and VA Medical Center, Kansas City, USA.
²⁷ Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, USA.

PMID: 36749036
PMCID: PMC12136278
DOI: 10.1111/den.14531

Review

Benefits and challenges in implementation of artificial intelligence in colonoscopy: World Endoscopy Organization position statement

Yuichi Mori et al. Dig Endosc. 2023 May.

. 2023 May;35(4):422-429.

doi: 10.1111/den.14531. Epub 2023 Mar 13.

Authors

Affiliations

¹ Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.
² Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
³ Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
⁴ Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK.
⁵ NIHR Oxford Biomedical Research Centre, Oxford, UK.
⁶ Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK.
⁷ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
⁸ Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.
⁹ Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
¹⁰ Department of Medicine, The University of British Columbia, Vancouver, Canada.
¹¹ Division of Gastroenterology, University of Montreal Medical Center (CHUM) and Research Center (CRCHUM), Montreal, Canada.
¹² School of Medicine, The University of Queensland, Brisbane, Australia.
¹³ Asian Institute of Gastroenterology, Hyderabad, India.
¹⁴ Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, United Arab Emirates.
¹⁵ Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
¹⁶ Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.
¹⁷ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
¹⁸ Swedish Medical Center, Seattle, USA.
¹⁹ Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
²⁰ Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan.
²¹ Jikei University School of Medicine, Tokyo, Japan.
²² Vikit Viranuvatti Siriraj GI Endoscopy Center, Mahidol University, Bangkok, Thailand.
²³ Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁴ Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
²⁵ University College London, London, UK.
²⁶ Division of Gastroenterology and Hepatology, University of Kansas School of Medicine and VA Medical Center, Kansas City, USA.
²⁷ Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, USA.

PMID: 36749036
PMCID: PMC12136278
DOI: 10.1111/den.14531

Abstract

The number of artificial intelligence (AI) tools for colonoscopy on the market is increasing with supporting clinical evidence. Nevertheless, their implementation is not going smoothly for a variety of reasons, including lack of data on clinical benefits and cost-effectiveness, lack of trustworthy guidelines, uncertain indications, and cost for implementation. To address this issue and better guide practitioners, the World Endoscopy Organization (WEO) has provided its perspective about the status of AI in colonoscopy as the position statement. WEO Position Statement: Statement 1.1: Computer-aided detection (CADe) for colorectal polyps is likely to improve colonoscopy effectiveness by reducing adenoma miss rates and thus increase adenoma detection; Statement 1.2: In the short term, use of CADe is likely to increase health-care costs by detecting more adenomas; Statement 1.3: In the long term, the increased cost by CADe could be balanced by savings in costs related to cancer treatment (surgery, chemotherapy, palliative care) due to CADe-related cancer prevention; Statement 1.4: Health-care delivery systems and authorities should evaluate the cost-effectiveness of CADe to support its use in clinical practice; Statement 2.1: Computer-aided diagnosis (CADx) for diminutive polyps (≤5 mm), when it has sufficient accuracy, is expected to reduce health-care costs by reducing polypectomies, pathological examinations, or both; Statement 2.2: Health-care delivery systems and authorities should evaluate the cost-effectiveness of CADx to support its use in clinical practice; Statement 3: We recommend that a broad range of high-quality cost-effectiveness research should be undertaken to understand whether AI implementation benefits populations and societies in different health-care systems.

Keywords: colon polyp; colonoscopy.

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Conflict of interest statement

Y.M.: Olympus Corporation (speaker fee, consultancy and equipment on loan) and Cybernet Systems Corporation (ownership interest). J.E.E.: Satisfai Health (ownership interest and consultancy); Medtronic, Falk and Jannsen (speaker fee); PAION (consultancy). C.H.: Medtronic (consultancy and equipment on loan), Fujifilm (consultancy and equipment on loan) and Pentax (consultancy). O.F.A.: Olympus Corporation (speaker fee). T.M.B.: Medtronic, Wision A.I., Magentiq Eye, DocBot and RSIP Vision (consultancy). M.B.: Satisfai Health (CEO and shareholder). D.v.R.: ERBE, Ventage, Pendopharm, Fujifilm and Pentax (research funding); Boston Scientific, ERBE, Fujifilm and Pendopharm (consultancy). D.G.H.: Olympus Australia Pty Ltd and Fresenius Kabi Pty Ltd (consulting fee); Olympus Australia Pty Ltd, Fresenius Kabi Pty Ltd and Boston Scientific Pty Ltd (speaker honorarium). A.R.: Medtronic and Fujifilm (consultancy and equipment on loan). S.K.: Olympus Corporation (speaker fee) and Cybernet Systems Corporation (ownership interest). M.M.: Olympus Corporation (speaker fee and consultancy), Cybernet Systems Corporation (ownership interest) and Associate Editor of Digestive Endoscopy. S.P.: Covidien LP, Fujifilm USA, Mahana Therapeutics, Allen Institute for Artificial Intelligence and Quasal AI (consultancy); Fujifilm USA and Paul Allen Center for Cancer Research (grant support). C.O.M.: AI Medical Service Inc (employee). H.O.: AbbVie GK, Mochida Pharmaceutical Co., Ltd., Kyorin Pharmaceutical Company, Limited, Mitsubishi Tanabe Pharma Corporation, Otsuka Pharmaceutical Co., Ltd, Takeda Pharmaceutical Company Limited, EA Pharma Co., Ltd, JIMRO Co., Ltd, ZERIA Pharmaceutical Co., Ltd and Boston Scientific Corporation (donation towards scholarships); Olympus Corporation and Takeda Pharmaceutical Company Limited (consulting fee); Takeda Pharmaceutical Company Limited, Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, Mochida Seiyaku Co., Ltd, EA Pharma Co., Ltd, Covidien Japan Inc., AbbVie GK, Kyorin Pharmaceutical Company, Limited, Pfizer Inc., Otsuka Pharmaceutical Co., Ltd, Fujifilm Medical Co., Ltd, Olympus Corporation and Viatris Inc. (speaker fee). E.D.: Fujifilm (device on loan, consultancy, research grant and speaker fee); Olympus, GI Supply, PAION and Ambu (consultancy); Olympus, GI Supply, Norgine, IPSEN and PAION (speaker fee). P.S.: Medtronic, Olympus Corporation, Boston Scientific, Fujifilm, Salix Pharmaceuticals and Lumendi (consultancy); Ironwood Pharmaceuticals, Erbe, Docbot, Cosmo Pharmaceuticals and CDx Laboratories, Inc. (research grant). D.K.R.: Olympus Corporation, Boston Scientific, Aries Pharmaceutical, Braintree Laboratories, Lumendi, Norgine, Endokey, GI Supply, Medtronic and Acacia Pharmaceuticals (consultancy); Olympus Corporation, Medivators, Erbe USA Inc and Braintree Laboratories (research support); Satisfai Health (shareholder). The other authors declare no conflict of interest for this article.

Figures

**Figure 1**
Left, computer‐aided detection for colorectal polyps (EndoBRAIN; Olympus Corp., Tokyo, Japan); right, computer‐aided diagnosis for colorectal polyps (GI GENIUS CADx; Medtronic Corp., Dublin, Ireland).

**Figure 2**
Possible cost increase and reduction introduced by artificial intelligence (AI) in colonoscopy. ADR, adenoma detection rate.

See this image and copyright information in PMC

References

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1. Mori Y, Neumann H, Misawa M, Kudo SE, Bretthauer M. Artificial intelligence in colonoscopy – Now on the market. What's next? J Gastroenterol Hepatol 2021; 36: 7–11. - PubMed
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Benefits and challenges in implementation of artificial intelligence in colonoscopy: World Endoscopy Organization position statement

Affiliations

Benefits and challenges in implementation of artificial intelligence in colonoscopy: World Endoscopy Organization position statement

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical