AI polyp detection is now routine in many endoscopy suites. GI leaders said it’s raising a training question: Can the next generation of gastroenterologists find polyps without it?
“Are you an AI endoscopist who doesn’t really know how to find a polyp?” said Sri Komanduri, MD, associate chief of the gastroenterology and hepatology division and director of digestive health system integration at Northwestern Medicine in Chicago. He spoke Oct. 30 at Becker’s 32nd Annual Meeting: The Business and Operations of ASCs in Chicago.
Dr. Komanduri said the concern has pushed many training programs to adopt policies on AI use. He compared it to self-driving cars. His Tesla handled Chicago traffic well, he said, but stuttered and nearly threw him forward when geese crossed a local street.
“If we start from day one … and our fellows who are going to be the people doing your colonoscopies don’t know how to drive the car themselves, I think it’s a problem,” he said. “We’re not ready for it yet.”
The evidence on skill loss is early. A multicenter observational study published Aug. 13, 2025, in The Lancet Gastroenterology & Hepatology looked at 19 experienced endoscopists at four centers in Poland. Their adenoma detection rate in colonoscopies done without AI fell from 28.4% to 22.4% in the three months after the centers began using AI. The study covered 1,443 colonoscopies, and the centers used Olympus’ ENDO-AID system. A commentary in the American College of Gastroenterology’s Evidence-Based GI said the design is open to confounding and did not report withdrawal times. It called for prospective trials.
With AI in use, the gains are clearer. A cluster-randomized Veterans Health Administration study of more than 334,000 colonoscopies, published in Gastroenterology in July 2026, tracked sites that adopted GI Genius. Their adenoma detection rate rose from 50.7% to 54.9%, while control sites stayed flat. About a quarter of surveyed VA endoscopists said they worried about overreliance.
Medical societies haven’t endorsed routine use. The American Gastroenterological Association’s March 2025 living guideline made no recommendation for or against computer-aided detection. In its review of 44 randomized trials, the AI-assisted adenoma detection rate was 44.8%, compared with 37.4% without it. The gains came mostly from small polyps with low cancer risk.
During the panel, Benjamin Levy, MD, a gastroenterologist at the University of Chicago, said many residents assume computer-aided detection will fix missed polyps on its own.
“It’s only as good as how we use it,” Dr. Levy said. Endoscopists still need to look behind folds and at the edges of the screen, he said.
He added that practices should track adenoma detection rates after adopting tools like Medtronic’s GI Genius to make sure the rates “continue to rise and not decline because people are becoming too reliant on this technology.”
He compared the current technology to the first iPhone and expects it to improve, especially at finding flat lesions in the right colon. He said the biggest payoff could come from a practice’s lowest performers. AI paired with longer withdrawal times could lift endoscopists with adenoma detection rates of 20% to 25% toward 50%. U.S. quality guidelines set a 35% target.
The results aren’t guaranteed. At a separate session on AI, an audience member said his group has used GI Genius for about five years without seeing its adenoma detection rate improve. A 2022 Stanford pragmatic trial published in Gastroenterology also found GI Genius did not improve colonoscopist performance in routine practice.
The FDA cleared GI Genius in April 2021 based on an Italian randomized trial. With the device, endoscopists found at least one adenoma or carcinoma in 55.1% of patients, compared with 42% with standard colonoscopy.
Dr. Komanduri said training also needs to keep pace as GI shifts toward therapeutic procedures. Fellows and junior faculty need to be able to remove polyps themselves.
“That sounds very intuitive, but that’s not the case,” he said. “The kids are not learning how to drive.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
