Artificial intelligence implementation in pancreaticobiliary endoscopy

Introduction: Artificial intelligence has been rapidly deployed in gastroenterology and endoscopy. The acceleration of deep convolutional neural networks along with hardware development has allowed implementation of artificial intelligence algorithms into real-time endoscopy, particularly colonoscopy. However, artificial intelligence implementation in pancreaticobiliary endoscopy is nascent. Areas Covered: Initial studies have been conducted in endoscopic retrograde pancreatography (ERCP), endoscopic ultrasound (EUS), and digital single operator cholangioscopy (DSOC). Machine learning has been implemented in identifying significant landmarks, including the ampulla on ERCP, and the bile duct, pancreas, and portal confluence on EUS. Moreover, artificial intelligence algorithms have been deployed in differentiating pathology including pancreas cancer, autoimmune pancreatitis, pancreatic cystic lesions, and biliary strictures. Expert Opinion: There have been relatively few studies with limited sample sizes in developing these machine learning algorithms. Despite the early successful demonstration of artificial intelligence in pancreaticobiliary endoscopy, additional research needs to be conducted with larger data sets to improve generalizability and assessed in real-time endoscopy before clinical implementation. However, pancreaticobiliary endoscopy remains a promising avenue of artificial intelligence application with the potential to improve clinical practice and outcomes.