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This ESGE Position Statement defines the expected value of artificial intelligence (AI) for the diagnosis and management of gastrointestinal neoplasia within the framework of the performance measures already defined by ESGE. This is based on the clinical relevance of the expected task and the preliminary evidence regarding artificial intelligence in artificial or clinical settings. MAIN RECOMMENDATIONS:: (1) For acceptance of AI in assessment of completeness of upper GI endoscopy, the adequate level of mucosal inspection with AI should be comparable to that assessed by experienced endoscopists. (2) For acceptance of AI in assessment of completeness of upper GI endoscopy, automated recognition and photodocumentation of relevant anatomical landmarks should be obtained in ≥90% of the procedures. (3) For acceptance of AI in the detection of Barrett's high grade intraepithelial neoplasia or cancer, the AI-assisted detection rate for suspicious lesions for targeted biopsies should be comparable to that of experienced endoscopists with or without advanced imaging techniques. (4) For acceptance of AI in the management of Barrett's neoplasia, AI-assisted selection of lesions amenable to endoscopic resection should be comparable to that of experienced endoscopists. (5) For acceptance of AI in the diagnosis of gastric precancerous conditions, AI-assisted diagnosis of atrophy and intestinal metaplasia should be comparable to that provided by the established biopsy protocol, including the estimation of extent, and consequent allocation to the correct endoscopic surveillance interval. (6) For acceptance of artificial intelligence for automated lesion detection in small-bowel capsule endoscopy (SBCE), the performance of AI-assisted reading should be comparable to that of experienced endoscopists for lesion detection, without increasing but possibly reducing the reading time of the operator. (7) For acceptance of AI in the detection of colorectal polyps, the AI-assisted adenoma detection rate should be comparable to that of experienced endoscopists. (8) For acceptance of AI optical diagnosis (computer-aided diagnosis [CADx]) of diminutive polyps (≤5 mm), AI-assisted characterization should match performance standards for implementing resect-and-discard and diagnose-and-leave strategies. (9) For acceptance of AI in the management of polyps ≥ 6 mm, AI-assisted characterization should be comparable to that of experienced endoscopists in selecting lesions amenable to endoscopic resection., Competing Interests: O.F. Ahmad has received speaker fees from Olympus (March 2022). G. Antonelli has received a consultancy fee from Medtronic. P. Bhandari’s department has received research grants from NEC Japan (June 2019, ongoing) and Fujifilm Europe (June 2020, ongoing). J.J.G.H.M. Bergman has received support for AI-related research in endoscopy from Olympus and and Fuijfilm; he has carried out sponsored AI-related research into Barrett’s esophagus for which the rights have been transferred to Olympus. R. Bisschops has received consultancy and speaker’s fees from Fujifilm, Pentax, and Medtronic (2015, ongoing), and provided consultancy to CDx Diagnostics (2017–2019); his department has received research grants from Pentax and Fujifilm (2015, ongoing), and from Medtronic (2018, ongoing). E. Dekker has received honoraria for consultancy from Fujifilm, Olympus, GI Supply, and PAION; she has received speakerʼs fees from Norgine, Ipsen, PAION, and Fujifilm. M. Dinis-Ribeiro has provided consultancy to Medtronic and Roche (2021–2022); his department has received support (loan for research) from Fujifilm (2021–2022); he is Co-Editor-in-Chief of Endoscopy journal. R. Eliakim has provided consultancy on various occasions to Medtronic (from 2019). I. Gralnek has provided consultancy to and been on the advisory board of Motus GI; he has provided consultancy to Boston Scientific, Clexio Biosciences, Medtronic, and Symbionix; he has received research support from Astra Zeneca and CheckCap; all during the last 3 years, 2019 to present. R.J. Haidry has received an educational grant to support research from Cook Endoscopy (2015, ongoing); his department has received an educational grant to support research from Medtronic (2018, ongoing). C. Hassan has received consulting fees and/or research grants from Alphasigma, Fujifilm, Medtronic, Norgine, Olympus, and Pentax. R. Joverʼs department has received a research grant from Medtronic (2021–2022). M.F. Kaminski has provided consultancy to Olympus (2016, ongoing) and Erbe (2021, ongoing), and has lectured for Boston Scientific (2016, ongoing) and Recordati (2020, ongoing). H. Messmann’s department has received financial and/or research support from Apollo Endosurgery, Biogen, Boston Scientific, CDx Diagnostics, Cook Medical, CSL Behring, Dr. Falk Pharma, Endo Tools Therapeutics, Erbe, Fujifilm, Hitachi, Janssen-Cilag, Medwork, Norgine, Nutricia, Olympus, Ovesco Endoscopy, Satisfai, Servier Deutschland, and US Endoscopy (in the past 3 years). Y. Mori has provided consultancy to and delivered talks for Olympus (2018–2022); he has ownership interest in Cybernet System Corporation (2020–2022). A. Repici has received research grants and speakerʼs fees from Boston Scientific (2020–2022), Fujifilm (2019–2022), and Norgine (2020–2022); he is also on an advisory board for Fujifilm (2019–2022). E. Rondonotti has been an Expert group member and speaker for Fujifilm (January–December 2021), and provided consultancy to Medtronic (July 2021–July 2022); his department received a research grant from Fujifilm (January–December 2021). Y. Saitoʼs department is conducting joint research with the NEC Corporation in developing AI for colonoscopy (April 2016–March 2023); he or his department will hold joint patents with the NEC Corporation, and five patents are pending. P. Sharma is providing consultancy services to Bausch, Boston Scientific, CDx Labs, Covidien LP, Exact Sciences, Fujifilm Medical Systems, Lucid, Lumendi, Medtronic, Phathom, Olympus, Takeda, and Samsung Bioepis (ongoing); his department is receiving research support from Cosmo Pharmaceuticals, Covidien, Docbot, ERBE, Fujifilm, Ironwood Pharmaceuticals, Olympus, and Medtronic. C. Spada has provided consultancy to Medtronic (2018–2022) and AnX Robotics (2018–2022). M. Abdelrahim, M. Areia, I. Boskoski, D. Domagk, A. Ebigbo, T. Eelbode, M. Häfner, R. Kuvaev, D. Libânio, M. Palazzo, M. Rutter, P. Sinonquel, M. Spadaccini, and A. Veitch have no competing interests., (European Society of Gastrointestinal Endoscopy. All rights reserved.)

The article discusses the quality improvement initiative of the European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) for the identification of upper gastrointestinal endoscopy (UGI) performance measures. Topics include the aim of the UGI working group, the performance measures accepted for upper gastrointestinal endoscopy, and the use of Delphi process in distinguishing the key performance measures.