Current status and future perspective on artificial intelligence for lower endoscopy

The global incidence and mortality rate of colorectal cancer remains high. Colonoscopy is regarded as the gold standard examination for detecting and eradicating neoplastic lesions. However, there are some uncertainties in colonoscopy practice that are related to limitations in human performance. First, approximately one-fourth of colorectal neoplasms are missed on a single colonoscopy. Second, it is still difficult for non-experts to perform adequately regarding optical biopsy. Third, recording of some quality indicators (e.g. cecal intubation, bowel preparation, and withdrawal speed) which are related to adenoma detection rate, is sometimes incomplete. With recent improvements in machine learning techniques and advances in computer performance, artificial intelligence-assisted computer-aided diagnosis is being increasingly utilized by endoscopists. In particular, the emergence of deep-learning, data-driven machine learning techniques have made the development of computer-aided systems easier than that of conventional machine learning techniques, the former currently being considered the standard artificial intelligence engine of computer-aided diagnosis by colonoscopy. To date, computer-aided detection systems seem to have improved the rate of detection of neoplasms. Additionally, computer-aided characterization systems may have the potential to improve diagnostic accuracy in real-time clinical practice. Furthermore, some artificial intelligence-assisted systems that aim to improve the quality of colonoscopy have been reported. The implementation of computer-aided system clinical practice may provide additional benefits such as helping in educational poorly performing endoscopists and supporting real-time clinical decision-making. In this review, we have focused on computer-aided diagnosis during colonoscopy reported by gastroenterologists and discussed its status, limitations, and future prospects.