Effectiveness and application of artificial intelligence for endoscopic screening of colorectal cancer: the future is now

IntroductionArtificial intelligence (AI) in gastrointestinal endoscopy includes systems designed to interpret medical images and increase sensitivity during examination. This may be a promising solution to human biases and may provide support during diagnostic endoscopy.Areas coveredThis review aims to summarize and evaluate data supporting AI technologies in lower endoscopy, addressing their effectiveness, limitations, and future perspectives.Expert opinionComputer-aided detection (CADe) systems have been studied with promising results, allowing for an increase in adenoma detection rate (ADR), adenoma per colonoscopy (APC), and a reduction in adenoma miss rate (AMR). This may lead to an increase in the sensitivity of endoscopic examinations and a reduction in the risk of interval-colorectal cancer. In addition, computer-aided characterization (CADx) has also been implemented, aiming to distinguish adenomatous and non-adenomatous lesions through real-time assessment using advanced endoscopic imaging techniques. Moreover, computer-aided quality (CADq) systems have been developed with the aim of standardizing quality measures in colonoscopy (e.g. withdrawal time and adequacy of bowel cleansing) both to improve the quality of examinations and set a reference standard for randomized controlled trials.