Artificial intelligence for kinematic (procedural motion) analysis in gastrointestinal endoscopy: A systematic review

Table 2 Multi-dimensional evidence imbalance between diagnostic artificial intelligence (computer-aided detection/ computer-aided diagnosis) and kinematic artificial intelligence (computer-aided quality) in gastrointestinal endoscopy

Evidence indicator	Diagnostic AI (CADe/CADx)	Kinematic AI (CAQ)	Ratio or qualitative gap
RCTs published	> 40	8	Approximately 5:1
Patients enrolled in RCTs	> 27000	Approximately 6200	Approximately 4:1
Systematic reviews/meta-analyses	> 10	0 (this is the first)	> 10:1
Regulatory approvals (FDA/CE/MFDS)	≥ 6 devices	0 standalone	Qualitative
GRADE certainty for primary outcome	High (ADR improvement)	Moderate (2 of 8 domains)	2 levels lower
Domains with ≥ 1 clinical trial	3/3 (detection, classification, characterization)	2/8 (withdrawal speed, coverage)	Qualitative
Domains with zero patient-level data	0/3	6/8 (75%)	Qualitative
Annual research output (2020-2024 PubMed)	Approximately 150 studies/year	Approximately 12 studies/year	Approximately 12:1
Industry investment in device development	Multiple companies (Medtronic, Fujifilm, NEC, Olympus, etc.)	Single academic platform dominates (ENDOANGEL)	Qualitative

Ratios are reported per indicator. No single composite number is used because indicators differ in magnitude (approximately 5:1 for randomized controlled trials, 4:1 for enrolled patients, approximately 12:1 for annual publication output, and qualitatively larger gaps for regulatory approvals and industry participation). CADe: Computer-aided detection; CADx: Computer-aided diagnosis; CAQ: Computer-aided quality; ADR: Adenoma detection rate; FDA: Food and Drug Administration; CE: Conformité Européenne; MFDS: Korean Ministry of Food and Drug Safety; AI: Artificial intelligence; RCT: Randomized controlled trial.