Multimodal artificial intelligence and large language models in gastrointestinal endoscopy: From lesion detection to workflow-integrated report generation

Table 2 Representative clinical and diagnostic-validation studies of artificial intelligence across gastrointestinal endoscopy tasks and workflows

Ref.	Region/setting	Population/sample size	AI function	Study design/comparator	Evaluation unit	Key findings	Validation/main limitation
Wang et al[7], 2019	China; colonoscopy	1058 patients; 522 CADe, 536 control	Real-time CADe	Prospective randomized trial; CADe vs standard colonoscopy	Patient	ADR: 29.1% vs 20.3%; adenomas/patient: 0.53 vs 0.31	Single-center, non-blinded trial; benefit mainly driven by diminutive adenomas
Byrne et al[8], 2019	Colonoscopy video	125 diminutive-polyp videos; 106 analyzed	CADx for adenoma vs hyperplastic polyp	Independent video test set; histopathology reference	Lesion/video	Sensitivity: 98%; specificity: 83%; accuracy: 94%; NPV: 97%	Offline video evaluation; 19/125 lesions lacked sufficient prediction confidence; no live clinical trial
Wu et al[9], 2019	China; EGD	324 randomized; 303 analyzed	WISENSE blind-spot monitoring	RCT; WISENSE-assisted vs conventional EGD	Patient/procedure	Blind spot rate: 5.86% vs 22.46%, P < 0.001	Single-center trial; procedure-quality endpoint
Gong et al[23], 2020	China; colonoscopy	704 randomized; 355 ENDOANGEL, 349 control	Real-time CADe/withdrawal-quality support	Randomized trial; ENDOANGEL vs unassisted colonoscopy	Patient	ADR: 16% vs 8%; odds ratio: 2.3, P = 0.001	Single-center study; relatively low baseline ADR
Wang et al[24], 2020	China; colonoscopy	1010 randomized; 962 analyzed	Real-time CADe	Double-blind randomized trial; CADe vs sham system	Patient	ADR: 34% vs 28%; odds ratio: 1.36, P = 0.03	Single-center; interval-CRC benefit not evaluated
Repici et al[25], 2020	Italy; colonoscopy	685 participants; 341 CADe, 344 control	GI Genius CADe	Multicenter randomized trial; CADe vs standard colonoscopy	Patient/procedure	ADR: 54.8% vs 40.4%; APC: 1.07 vs 0.71	Multicenter clinical evidence; no long-term cancer-outcome assessment
Shaukat et al[26], 2022	United States; screening/surveillance colonoscopy	1359 analyzed; 682 CADe, 677 standard	SKOUT CADe	Multicenter randomized trial; CADe vs standard colonoscopy	Patient/procedure	ADR: 47.8% vs 43.9%, P = 0.065; APC: 1.05 vs 0.83, P = 0.002	Multicenter United States evidence; ADR difference not statistically significant
Spada et al[36], 2024	14 European centers; small-bowel CE	137 enrolled; 133 analyzed	AI-assisted capsule reading	Prospective multicenter paired comparison; AI-assisted vs standard reading	Patient	Diagnostic yield: 73.7% vs 62.4%; reading time: 3.8 minutes vs 33.7 minutes	Strong workflow benefit; downstream management and clinical outcomes not evaluated
Seager et al[27], 2024	United Kingdom; 12 NHS hospitals	2032 randomized	GI Genius CADe	Pragmatic multicenter RCT; CADe vs standard colonoscopy	Patient/procedure	Adenomas/procedure: 1.56 vs 1.21; ADR: 56.6% vs 48.4%	Strong routine-practice evidence; open-label design
Maas et al[28], 2024	Europe/Canada; 7 centers	581 enrolled; 497 analyzed	CADe	International randomized trial; CADe vs conventional colonoscopy	Patient/procedure	ADR: 38.4% vs 37.7%; APC: 0.66 vs 0.66	Experienced endoscopists; not statistically significant
Yao et al[47], 2024	China; screening colonoscopy	393 patients	AI bowel-preparation assessment	Prospective observational validation; AI e-BBPS with tandem colonoscopy outcome assessment	Patient/procedure	> 5-mm AMR: 35.71% in unqualified-AI vs 13.19% in qualified-AI	Single-center observational study; no randomized AI-vs-standard intervention

Outcomes are reported as task-specific findings from the original studies and are not intended for direct comparison across different tasks, study designs, or evaluation metrics. AI: Artificial intelligence; CADe: Computer-aided detection; CADx: Computer-aided diagnosis; EGD: Esophagogastroduodenoscopy; GI: Gastrointestinal; ADR: Adenoma Detection Rate; APC: Adenomas per colonoscopy; CE: Capsule endoscopy; RCT: Randomized controlled trial; AMR: Adenoma miss rate; NPV: Negative predictive value; NHS: National Health Service.