Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Helmut Messmann; Raf Bisschops; Giulio Antonelli; Diogo Libânio; Pieter Sinonquel; Mohamed Abdelrahim; Omer F. Ahmad; Miguel Areia; Jacques J. G. H. M. Bergman; Pradeep Bhandari; Ivo Boskoski; Evelien Dekker; Dirk Domagk; Alanna Ebigbo; Tom Eelbode; Rami Eliakim; Michael Häfner; Rehan J. Haidry; Rodrigo Jover; Michal F. Kaminski; Roman Kuvaev; Yuichi Mori; Maxime Palazzo; Alessandro Repici; Emanuele Rondonotti; Matthew D. Rutter; Yutaka Saito; Prateek Sharma; Cristiano Spada; Marco Spadaccini; Andrew Veitch; Ian M. Gralnek; Cesare Hassan; Mario Dinis-Ribeiro

doi:10.1055/a-1950-5694

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Endoscopy 2022; 54(12): 1211-1231
DOI: 10.1055/a-1950-5694

Position Statement

Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Helmut Messmann‡

¹III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany

,

Raf Bisschops ‡

²Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospital Leuven, Leuven, Belgium

,

Giulio Antonelli

³Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy

⁴Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Italy

,

Diogo Libânio

⁵Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal

⁶MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal

,

Pieter Sinonquel

²Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospital Leuven, Leuven, Belgium

,

Mohamed Abdelrahim

⁷Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK

,

Omer F. Ahmad

⁸Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London Hospital, London, UK

⁹Division of Surgery and Interventional Sciences, University College London Hospital, London, UK

¹⁰Gastrointestinal Services, University College London Hospital, London, UK

,

Miguel Areia

¹¹Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal

,

Jacques J. G. H. M. Bergman

¹²Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands

,

Pradeep Bhandari

⁷Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK

,

Ivo Boskoski

¹³Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

,

Evelien Dekker

¹²Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands

,

Dirk Domagk

¹⁴Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany

,

Alanna Ebigbo

¹III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany

,

Tom Eelbode

¹⁵Department of Electrical Engineering (ESAT/PSI), Medical Imaging Research Center, KU Leuven, Leuven, Belgium

,

Rami Eliakim

¹⁶Department of Gastroenterology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel

,

Michael Häfner

¹⁷2nd Medical Department, Barmherzige Schwestern Krankenhaus, Vienna, Austria

,

Rehan J. Haidry

⁸Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London Hospital, London, UK

⁹Division of Surgery and Interventional Sciences, University College London Hospital, London, UK

,

Rodrigo Jover

¹⁸Servicio de Gastroenterología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica de Alicante ISABIAL, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain

,

Michal F. Kaminski

¹⁹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²⁰Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland

²¹Department of Oncological Gastroenterology and Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

,

Roman Kuvaev^**

²²Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation

²³Department of Gastroenterology, Faculty of Additional Professional Education, N.A. Pirogov Russian National Research Medical University, Moscow, Russian Federation

,

Yuichi Mori

¹⁹Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

²⁴Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Maxime Palazzo

²⁵European Hospital, Marseille, France

,

Alessandro Repici

²⁶Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy

²⁷IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Emanuele Rondonotti

²⁸Gastroenterology Unit, Valduce Hospital, Como, Italy

,

Matthew D. Rutter

²⁹North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK

³⁰Population Health Sciences Institute, Newcastle University, Newcastle, UK

,

Yutaka Saito

³¹Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

,

Prateek Sharma

³²Gastroenterology and Hepatology Division, University of Kansas School of Medicine, Kansas, USA

³³Kansas City VA Medical Center, Kansas City, USA

,

Cristiano Spada

¹³Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

³⁴Digestive Endoscopy, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy

,

Marco Spadaccini

²⁶Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy

²⁷IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Andrew Veitch

³⁵Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK

,

Ian M. Gralnek

³⁶Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel

³⁷Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

,

Cesare Hassan^***

²⁶Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy

²⁷IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Mario Dinis-Ribeiro^***

⁵Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal

› Author Affiliations

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Abstract

This ESGE Position Statement defines the expected value of artificial intelligence (AI) for the diagnosis and management of gastrointestinal neoplasia within the framework of the performance measures already defined by ESGE. This is based on the clinical relevance of the expected task and the preliminary evidence regarding artificial intelligence in artificial or clinical settings.

Main recommendations: (1) For acceptance of AI in assessment of completeness of upper GI endoscopy, the adequate level of mucosal inspection with AI should be comparable to that assessed by experienced endoscopists. (2) For acceptance of AI in assessment of completeness of upper GI endoscopy, automated recognition and photodocumentation of relevant anatomical landmarks should be obtained in ≥90% of the procedures. (3) For acceptance of AI in the detection of Barrett’s high grade intraepithelial neoplasia or cancer, the AI-assisted detection rate for suspicious lesions for targeted biopsies should be comparable to that of experienced endoscopists with or without advanced imaging techniques. (4) For acceptance of AI in the management of Barrett’s neoplasia, AI-assisted selection of lesions amenable to endoscopic resection should be comparable to that of experienced endoscopists. (5) For acceptance of AI in the diagnosis of gastric precancerous conditions, AI-assisted diagnosis of atrophy and intestinal metaplasia should be comparable to that provided by the established biopsy protocol, including the estimation of extent, and consequent allocation to the correct endoscopic surveillance interval. (6) For acceptance of artificial intelligence for automated lesion detection in small-bowel capsule endoscopy (SBCE), the performance of AI-assisted reading should be comparable to that of experienced endoscopists for lesion detection, without increasing but possibly reducing the reading time of the operator. (7) For acceptance of AI in the detection of colorectal polyps, the AI-assisted adenoma detection rate should be comparable to that of experienced endoscopists. (8) For acceptance of AI optical diagnosis (computer-aided diagnosis [CADx]) of diminutive polyps (≤5 mm), AI-assisted characterization should match performance standards for implementing resect-and-discard and diagnose-and-leave strategies. (9) For acceptance of AI in the management of polyps ≥ 6 mm, AI-assisted characterization should be comparable to that of experienced endoscopists in selecting lesions amenable to endoscopic resection.

^* Helmut Messmann and Raf Bisschops, first authors, contributed equally to this manuscript.

^** Although both ESGE and the Thieme Group adhere to a policy prohibiting publications by Russian authors in Endoscopy at this time, an exception has been made to include Dr. Kuvaev due to the fact that his significant contribution to this Position Statement was made before Russia’s invasion of Ukraine.

^*** Cesare Hassan and Mario Dinis-Ribeiro, senior authors, contributed equally to this manuscript.

Publication History

Article published online:
21 October 2022

Georg Thieme Verlag KG
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Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

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