AI in endoscopy and medicolegal issues: the computer is guilty in case of missed cancer?

puter (machines) programmed to simulate human intelligence in problem-solving and learned behavior, has changed modus operandi in many areas (elements) of our lives. It is being used in a wide range of activities, such as banking, remote sensing, transportation, healthcare, and more [1]. In medicine, AI platforms already exist and soon may become indispensable for early detection, characterization, and classification of several gastrointestinal disorders including Barrett esophagus, stomach and colonic lesions [2–5]. Basically, it represents computer-derived decision-making algorithms that are developed comparing data from a specific patient with large quantities of data from other patients and it has been repeatedly claimed that such projects will automate doctors’ work soon [1, 2]. Before it happens and alongside technical challenges that implementation and integration of AI in clinical practice pose to engineers and medical workers, there are a series of open questions and legal issues that need to be addressed. Due to their wide and ever-increasing presence in our lives, AI machines may soon gain some social capacity in terms of affecting our emotions and responsiveness, so the crucial question is whether AI will ever replace doctors in the future and how many people will support this happening. We have seen, from the survey by Wadhawa et al. [6] of 124 US gastroenterologists, 86% of them have a strong interest in applying AI in their daily practice and nearly 85% among them think it would improve their practice. On the other hand, only 57% would rely on a decision made by AI. So, the answer to the question about whether AI will replace doctors in the future is far from being simple and straightforward. One thing is for sure is that once an AI system is linked to the doctor-patient relationship, matters will become more complex. One of the complexities in the dilemma is whether AI can be held accountable for misdiagnosis or even malpractice. Well, perhaps one day, and then if some circumstances are studied and examined to apportion accountability. The first and perhaps most fundamental concern is validation of algorithms and classification of the product (software). Recently, several algorithms have been developed for detection and characterization of colon polyps and they are in clinical trials or under approval in Europe, Japan, and the United States [5, 7–9]. Once a model is tested on large amounts of internal and external image data sets (internal and external validation), an AI system can be used safely in the clinical setting. If such a system is intended to detect or treat disease, according to the European Medical Devices Regulations, it can be classified as a medical device that contributes to diagnosis and facilitates decision-making on therapeutic measures [10]. If we standardize AI design and have it registered as a medical device and request that ethical, moral, and social norms be programmed into AI platforms that interact with humans, then we are obliged to determine under which circumstances they can be held legally responsible for their actions. At this stage, healthcare professionals would be responsible for harm if they did not take adequate measures to properly evaluate AI technology. But as technology advances, machines are likely to gain more autonomy and the strategy in relation to legal responsibility needs to be further developed. All AI systems are designed and built by humans with the intent of doing no harm to other human and achieving their goals in a safe and secure manner. It will be challenging, however, to find responAI in endoscopy and medicolegal issues: the computer is guilty in case of missed cancer?