Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study.

Background: It is not known if continuous exposure to artificial intelligence (AI) changes endoscopists' behaviour when conducting colonoscopy. We assessed how endoscopists who regularly used AI performed colonoscopy when AI was not in use.

Methods: We conducted a retrospective, observational study at four endoscopy centres in Poland taking part in the ACCEPT (Artificial Intelligence in Colonoscopy for Cancer Prevention) trial. These centres introduced AI tools for polyp detection at the end of 2021, after which colonoscopies had been randomly assigned to be conducted with or without AI assistance according to the date of examination. We evaluated the quality of colonoscopy by comparing two different phases: 3 months before and 3 months after AI implementation. We included all diagnostic colonoscopies, excluding those involving intensive anticoagulant use, pregnancy, or a history of colorectal resection or inflammatory bowel disease. The primary outcome was change in adenoma detection rate (ADR) of standard, non-AI assisted colonoscopy before and after AI exposure. Multivariable logistic regression was done to identify independent factors affecting ADR.

Findings: Between Sept 8, 2021, and March 9, 2022, 1443 patients underwent non-AI assisted colonoscopy before (n=795) and after (n=648) the introduction of AI (median age 61 years [IQR 45-70], 847 [58·7%] female, 596 [41·3%] male). The ADR of standard colonoscopy decreased significantly from 28·4% (226 of 795) before to 22·4% (145 of 648) after exposure to AI, corresponding with an absolute difference of -6·0% (95% CI -10·5 to -1·6; p=0·0089). In multivariable logistic regression analysis, exposure to AI (odds ratio 0·69 [95% CI 0·53-0·89]), male versus female patient sex (1·78 [1·38-2·30]), and patient age ≥60 years versus <60 years (3·60 [2·74-4·72]) were the independent factors significantly associated with ADR.

Interpretation: Continuous exposure to AI might reduce the ADR of standard non-AI assisted colonoscopy, suggesting a negative effect on endoscopist behaviour.

Funding: European Commission and Japan Society for the Promotion of Science.