The slope of enlightenment: Towards a more realistic understanding of the strengths and weaknesses of artificial intelligence for colorectal polyp assessment
In brief
AI modestly boosts polyp detection but real-world gains are variable
Deep-learning tools increase lesion recognition and enable real-time optical diagnosis, yet real-world studies show only modest, inconsistent improvements in adenoma detection and higher false-positive rates. Integration challenges and medicolegal concerns temper enthusiasm, highlighting the need for multicenter validation and standardized reporting before AI can reliably enhance colorectal cancer screening.
- Journal
- Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Q1)
- Published
- 13 July 2026
- Study design
- Narrative review / expert opinion
- Evidence level
- Level 1, High (CEBM 5)
- Authors
- Pieter Sinonquel, Giulio Antonelli
- PMID
- 42442968
- DOI
- 10.1016/j.dld.2026.06.017
Why clinicians should know about it
- Picked for Hepatology (top studies of the week, 19 July 2026): Recent Hepatology research from a high-quartile journal.
Abstract
Artificial intelligence (AI) has rapidly evolved into a transformative adjunct to gastrointestinal (GI) endoscopy, particularly through deep-learning-based computer-aided detection (CADe) and diagnosis (CADx) systems. Early randomized controlled trials demonstrated substantial improvements in adenoma and polyp detection, fueling high expectations for AI-enhanced screening performance. However, real-world evidence has since revealed more modest and heterogeneous benefits, underscoring the challenges of generalizability, algorithmic transparency, workflow integration, and user engagement. This review synthesizes the current state of AI in colorectal cancer screening and polyp assessment, outlining both its strengths-including improved lesion recognition, enhanced quality assurance, and potential for real-time optical diagnosis and its limitations, such as false positives, variable clinical impact, medicolegal uncertainties, and the risk of cognitive offloading. Positioned along the "slope of enlightenment" of the Gartner Hype Cycle, AI in endoscopy is entering a phase of maturation characterized by pragmatic adoption, refined human-AI interaction and development of multimodal, explainable systems. Continued multicenter validation, standardized reporting, and responsible integration are essential to assess the technology's long-term value and achieving sustainable improvements in endoscopic quality and future colorectal cancer prevention.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.