Abstract
Abstract Introduction Endoscopy plays a key role in the surveillance of patients with Barrett’s esophagus and the diagnosis of esophageal cancer. The subtleties of endoscopic interpretation are subject to clinical expertise, diagnostic skill, and thus human error. Therefore, artificial intelligence (AI) is increasingly being incorporated into endoscopy in order to improve diagnostic accuracy and early detection. This systematic review and meta-analysis consolidates the evidence on the use of AI in the endoscopic diagnosis of esophageal cancer. Methods The systematic review was carried out using Pubmed, MEDLINE and Ovid EMBASE databases as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies which described the role of AI in supporting endoscopic video or image diagnosis of esophageal cancer were included. A meta-analysis was also performed. Results 45 studies formed the qualitative and quantitative review. 14 studies with 1590 patients in total assessed the use of AI in endoscopic diagnosis of esophageal squamous cell carcinoma (ESCC)- the pooled sensitivity and specificity were 91.2% (84.3–95.2%) and 80% (64.3–89.9%). A further, 9 studies consisting of 478 patients overall explored the capabilities of AI in supporting the endoscopic diagnosis of esophageal adenocarcinoma (EAC), with a pooled sensitivity and specificity of 93.1% (86.8–96.4%) and 86.9% (81.7–90.7%). AI was often superior to endoscopists when diagnosing ESCC and improved the overall accuracy of both novice and expert endoscopists. Conclusion AI technology, as an adjunct to endoscopy has proven to be beneficial in early, accurate detection of esophageal malignancy. Multiple studies have shown superior diagnostic capabilities when comparing AI technology to endoscopists alone. Despite promising results, the application in real-time endoscopy is limited, and further multicenter trials are required to accurately assess its use in routine practice.
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