Machine learning in colorectal polyp surveillance: A paradigm shift in post-endoscopic mucosal resection follow-up

Colorectal cancer remains a major health concern, with colorectal polyps as key precursors. Endoscopic mucosal resection (EMR) is a common treatment, but recurrence rates remain high. Traditional surveillance strategies rely on polyp characteristics and completeness of the resection potentially missing key risk factors. Machine learning (ML) offers a transformative approach by integrating patient-specific data to refine risk stratification. Recent studies highlight ML models, such as Extreme Gradient Boosting, which outperform conventional methods in predicting polyp recurrence within one-year post-EMR. These models incorporate factors like age, smoking status, family history, and pathology, optimizing follow-up recommendations and minimizing unnecessary procedures. Artificial intelligence (AI)-driven tools and web-based calculators enhance clinical workflow by providing real-time, personalized risk assessments. However, challenges remain in external validation, model interpretability, and clinical integration. Future surveillance strategies should combine expert judgment with AI insights to optimize patient outcomes. As gastroenterology embraces AI, ML-driven surveillance represents a paradigm shift, advancing precision medicine in colorectal polyp management. This editorial explores AI's role in transforming post-EMR follow-up, addressing benefits, limitations, and future directions.