Opportunities and challenges of artificial intelligence-assisted endoscopy and high-quality data for esophageal squamous cell carcinoma

This review comprehensively summarized the potential of artificial intelligence (AI) in the management of esophageal cancer. It highlighted the significance of AI-assisted endoscopy in Japan where endoscopy is central to both screening and diagnosis. For the clinical adaptation of AI, several challenges remain for its effective translation. The establishment of high-quality clinical databases, such as the National Clinical Database and Japan Endoscopy Database in Japan, which covers almost all cases of esophageal cancer, is essential for validating multimodal AI models. This requires rigorous external validation using diverse datasets, including those from different endoscope manufacturers and image qualities. Furthermore, endoscopists' skills significantly affect diagnostic accuracy, suggesting that AI should serve as a supportive tool rather than a replacement. Addressing these challenges, along with country-specific legal and ethical considerations, will facilitate the successful integration of multimodal AI into the management of esophageal cancer, particularly in endoscopic diagnosis, and contribute to improved patient outcomes. Although this review focused on Japan as a case study, the challenges and solutions described are broadly applicable to other high-incidence regions.