AI in colonoscopy - detection and characterisation of malignant polyps

The medical technological revolution has transformed the nature with which we deliver care. Adjuncts such as artificial intelligence and machine learning have underpinned this. The applications to the field of endoscopy are numerous. Malignant polyps represent a significant diagnostic dilemma as they lie in an area in which mischaracterisation may mean the difference between an endoscopic procedure and a formal bowel resection. This has implications for patients’ oncological outcomes, morbidity and mortality, especially if post-procedure histopathology upstages disease. We have made significant strides with the applications of artificial intelligence to colonoscopic detection. Deep learning algorithms are able to be created from video and image databases. These have been applied to traditional, human-derived, classification methods, such as Paris or Kudo, with up to 93% accuracy. Furthermore, multimodal characterisation systems have been developed, which also factor in patient demographics and colonic location to provide an estimation of invasion and endoscopic resectability with over 90% accuracy. Although the technology is still evolving, and the lack of high-quality randomised controlled trials limits clinical usability, there is an exciting horizon upon us for artificial intelligence-augmented endoscopy.