Application of Explainable Artificial Intelligence Based on Visual Explanation in Digestive Endoscopy

At present, artificial intelligence (AI) has shown significant potential in digestive endoscopy image analysis, serving as a powerful auxiliary tool for the accurate diagnosis and treatment of gastrointestinal diseases. However, mainstream models represented by deep learning are often characterized as complex "black boxes," with decision-making processes that are difficult for humans to interpret. The lack of interpretability undermines physicians' trust in model results and hinders the broader use of models in clinical practice. To address this core challenge, Explainable AI (XAI) has emerged to enhance the transparency of decision-making, thereby establishing a foundation of trust for human-machine collaboration. The review systematically reviews 34 articles (7 articles in esophagogastroduodenoscopy, 13 articles in colonoscopy, 9 articles in endoscopic ultrasonography, and 5 articles in wireless capsule endoscopy), focusing on the research progress and applications of XAI in the field of digestive endoscopic image analysis, with particular emphasis on the visual explanation-based methods. We first clarify the definition and mainstream classification of XAI, then introduce the principles and characteristics of key XAI methods based on visual explanation. Subsequently, we review the applications of these methods in digestive endoscopy image analysis. Lastly, we explore the obstacles presently faced in this domain and the future directions. This study provides a theoretical basis for constructing a trustworthy and transparent AI-assisted digestive endoscopy diagnosis and treatment system and promotes the implementation and application of XAI in clinical practice.