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

Table 3 Risk of bias assessment (Cochrane Risk of Bias 2 for randomized controlled trials)

Ref.	D1: Randomization	D2: Deviations from intended interventions	D3: Missing outcome data	D4: Measurement of outcome	D5: Selection of reported result	Overall
Gong et al[1], 2020	Low (computer-generated, sealed envelopes)	High (real-time AI display; inherently unblindable)	Low (ITT; 2.1% attrition)	Low (histopathology reference; blinded pathologist)	Low (pre-registered; all outcomes reported)	Some concerns (unblinding inevitable)
Su et al[2], 2020	Low (computer-generated randomization)	High (real-time AI overlay visible to endoscopist)	Low (ITT; < 3% missing)	Low (histopathology reference; blinded assessment)	Low (pre-registered; primary/secondary endpoints reported)	Some concerns (unblinding inevitable)
Yao et al[9], 2022	Low (computer-generated; 4-arm parallel design)	High (CAQ display visible; endoscopist aware of AI arm)	Low (ITT; complete follow-up)	Low (histopathology; blinded pathologist)	Low (pre-registered 4-arm design; all outcomes reported)	Some concerns (unblinding inevitable)
Wu et al[30], 2019	Low (computer-generated; concealed allocation)	High (WISENSE display visible during EGD)	Low (complete data; no attrition)	Low (blind spot count by independent reviewer)	Low (pre-registered; all endpoints reported)	Some concerns (unblinding inevitable)
Chen et al[60], 2020	Low (computer-generated randomization)	High (AI display visible during EGD)	Low (< 2% missing; ITT)	Low (blind spot assessment by blinded reviewer)	Low (all pre-specified outcomes reported)	Some concerns (unblinding inevitable)
Wu et al[31], 2021	Low (centralized randomization; 5-hospital)	High (real-time AI feedback visible to endoscopist)	Low (ITT; minimal attrition)	Low (blind spot mapping by independent reviewer)	Low (pre-registered multicenter; all outcomes reported)	Some concerns (unblinding inevitable)
Yao et al[40], 2024	Low (computer-generated; tandem design)	High (AI assistance visible during colonoscopy)	Low (complete follow-up; tandem design ensures paired data)	Some concerns (miss rate depends on tandem sequence; learning effect possible)	Low (pre-registered tandem RCT; all outcomes reported)	Some concerns (unblinding + potential tandem sequence effect)
Liu et al[27], 2025	Low (centralized randomization; 6-center)	High (real-time AI quality control visible)	Low (ITT; < 3% attrition across 6 centers)	Low (histopathology; blinded pathologist)	Low (pre-registered multicenter; all outcomes reported)	Some concerns (unblinding inevitable)

RCT: Randomized controlled trial; AI: Artificial intelligence; ITT: Intention-to-treat; CAQ: Computer-aided quality; EGD: Esophagogastroduodenoscopy.