From hype to clinical translation: A tiered, readiness-based framework for artificial intelligence in gastrointestinal endoscopy

Table 3 Priority translational agenda for the next 3 years to 5 years

Priority	Why it matters	Example deliverable
Patient-important outcomes for Tier 1 colonoscopy AI	ADR alone is no longer sufficient to justify broad adoption given that most incremental yield is from diminutive lesions	Multicenter registry or pragmatic trial accompanying (not following) rollout and measuring advanced neoplasia, interval cancer surrogates, low-value resection rate, and surveillance intensity
Pathway-defining trials for tier 2 tools	Technical accuracy does not establish net clinical value	Capsule AI trial measuring reading time, false-positive burden, downstream procedure rate, and cost; H. pylori study linking AI outputs to biopsy strategy and management
Global generalizability	Current literature is concentrated in a few regions and expert centres	Prospective validation across underrepresented geographies and lower-resource settings, including South Asia, Latin America, and sub-Saharan Africa
Human-factors safeguards as a standard requirement	Automation bias can erode clinician performance, as the deskilling signal in colonoscopy demonstrates	Mandatory AI-off benchmarking, override logging, and discordant-case review as part of every rollout protocol
Governance before guideline endorsement	Deployment without accountability is operationally fragile	Minimum package of update disclosure, drift monitoring, and escalation policy before any tier 2 system receives society-level endorsement
CADx pathway clarification	Two major meta-analyses show no net benefit of current CADx in routine practice; the resect-and-discard pathway requires society-level redefinition before AI-assisted optical diagnosis can be broadly implemented	Prospective pragmatic trial comparing AI-assisted resect-and-discard vs standard practice on histopathology concordance, surveillance interval assignment, and medicolegal framework

AI: Artificial intelligence; ADR: Adenoma detection rate; H. pylori: Helicobacter pylori; CADx: Computer-aided diagnosis.