1
|
Wang K, Xu WT, Kou WJ, Qi XS. Factors affecting cecal intubation time during colonoscopy. Shijie Huaren Xiaohua Zazhi 2023; 31:105-112. [DOI: 10.11569/wcjd.v31.i3.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In recent years, the morbidity and mortality of colorectal cancer (CRC) have increased significantly in China, and it has become one of the major malignancies that threaten the health of residents. Colonoscopy is the gold standard for the diagnosis of CRC. High-quality colonoscopy can effectively reduce the mortality of CRC. Cecal intubation time (CIT) is one of the indicators to reflect the quality of colonoscopy. Studies have found that many factors can affect CIT. This paper reviews the literature to identify the factors that affect CIT, such as those related to doctors, patients, assistive technologies, and equipment, in order to improve the quality of colonoscopy performed by endoscopists.
Collapse
Affiliation(s)
- Ke Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Wen-Tao Xu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
| | - Wen-Jing Kou
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Xing-Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| |
Collapse
|
2
|
Tang CP, Lin TL, Hsieh YH, Hsieh CH, Tseng CW, Leung FW. Polyp detection and false-positive rates by computer-aided analysis of withdrawal-phase videos of colonoscopy of the right-sided colon segment in a randomized controlled trial comparing water exchange and air insufflation. Gastrointest Endosc 2022; 95:1198-1206.e6. [PMID: 34973967 DOI: 10.1016/j.gie.2021.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Water exchange (WE) improves lesion detection but misses polyps because of human limitations. Computer-aided detection (CADe) identifies additional polyps overlooked by the colonoscopist. Additional polyp detection rate (APDR) is the proportion of patients with at least 1 additional polyp detected by CADe. The number of false positives (because of feces and air bubble) per colonoscopy (FPPC) is a major CADe limitation, which might be reduced by salvage cleaning with WE. We compared the APDR and FPPC by CADe between videos of WE and air insufflation in the right-sided colon. METHODS CADe used a convolutional neural network with transfer learning. We edited and coded withdrawal-phase videos in a randomized controlled trial that compared right-sided colon findings between air insufflation and WE. Two experienced blinded endoscopists analyzed the CADe-overlaid videos and identified additional polyps by consensus. An artifact triggered by CADe but not considered a polyp by the reviewers was defined as a false positive. The primary outcome was APDR. RESULTS Two hundred forty-five coded videos of colonoscopies inserted with WE (n = 123) and air insufflation (n = 122) methods were analyzed. The APDR in the WE group was significantly higher (37 [30.1%] vs 15 [12.3%], P = .001). The mean [standard deviation] FPPC related to feces (1.78 [1.67] vs 2.09 [2.09], P = .007) and bubbles (.53 [.89] vs 1.25 [2.45], P = .001) in the WE group were significantly lower. CONCLUSIONS CADe showed significantly higher APDR and lower number of FPPC related to feces and bubbles in the WE group. The results support the hypothesis that the strengths of CADe and WE complement the weaknesses of each other in optimizing polyp detection.
Collapse
Affiliation(s)
- Chia-Pei Tang
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Tu-Liang Lin
- Department of Management Information Systems, National Chiayi University, Chiayi, Taiwan
| | - Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Chen-Hung Hsieh
- Department of Management Information Systems, National Chiayi University, Chiayi, Taiwan
| | - Chih-Wei Tseng
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California, USA; David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| |
Collapse
|
3
|
Computer-Aided Colon Polyp Detection on High Resolution Colonoscopy Using Transfer Learning Techniques. SENSORS 2021; 21:s21165315. [PMID: 34450756 PMCID: PMC8402119 DOI: 10.3390/s21165315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 01/10/2023]
Abstract
Colonoscopies reduce the incidence of colorectal cancer through early recognition and resecting of the colon polyps. However, the colon polyp miss detection rate is as high as 26% in conventional colonoscopy. The search for methods to decrease the polyp miss rate is nowadays a paramount task. A number of algorithms or systems have been developed to enhance polyp detection, but few are suitable for real-time detection or classification due to their limited computational ability. Recent studies indicate that the automated colon polyp detection system is developing at an astonishing speed. Real-time detection with classification is still a yet to be explored field. Newer image pattern recognition algorithms with convolutional neuro-network (CNN) transfer learning has shed light on this topic. We proposed a study using real-time colonoscopies with the CNN transfer learning approach. Several multi-class classifiers were trained and mAP ranged from 38% to 49%. Based on an Inception v2 model, a detector adopting a Faster R-CNN was trained. The mAP of the detector was 77%, which was an improvement of 35% compared to the same type of multi-class classifier. Therefore, our results indicated that the polyp detection model could attain a high accuracy, but the polyp type classification still leaves room for improvement.
Collapse
|
4
|
Hosoe N, Limpias Kamiya KJL, Hayashi Y, Sujino T, Ogata H, Kanai T. Current status of colon capsule endoscopy. Dig Endosc 2021; 33:529-537. [PMID: 32542702 DOI: 10.1111/den.13769] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
While both the annual incidence and mortality of colorectal cancer are slowly but steadily decreasing in the United States, the incidence of such malignancy is increasing in Japan. Thus, controlling colorectal cancer in Japan is a major concern. In 2006, colon capsule endoscopy was first introduced by Eliakim et al. First-generation colon capsule endoscopy had a moderate sensitivity for detecting polyps of more than 6 mm. Thus, second-generation colon capsule endoscopy was developed to achieve higher sensitivity. Colonoscopy is the gold standard tool for colorectal cancer surveillance. With an improvement in the imaging function, the performance of second-generation colon capsule endoscopy is almost as satisfactory as that of colonoscopy. Certain situations, such as incomplete colonoscopy and contraindication for use of sedation, can benefit from colon capsule endoscopy. Colon capsule endoscopy requires a more extensive bowel preparation than colonoscopy and computed tomography colonography because it requires laxatives not only for bowel cleansing but also for promoting the excretion of the capsule. Another problem with colon capsule endoscopy includes the burden of reading and interpretation and overlook of the lesions. Currently, the development of automatic diagnosis of colon capsule endoscopy using artificial intelligence is still under progress. Although the available guidelines do not support the use of colon capsule endoscopy for inflammatory bowel disease, the possible application of colon capsule endoscopy is ulcerative colitis. This review article summarizes and focuses on the current status of colon capsule endoscopy for colorectal cancer screening and the possibility for its applicability on inflammatory bowel disease.
Collapse
Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Kenji J L Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomohisa Sujino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Leung FW, Hsieh YH. Artificial intelligence (computer-assisted detection) is the most recent novel approach to increase adenoma detection. Gastrointest Endosc 2021; 93:86-88. [PMID: 33353642 DOI: 10.1016/j.gie.2020.07.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/28/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California, USA; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA
| | - Yu-Hsi Hsieh
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan; Tzu Chi University, Hualien City, Hualien, Taiwan
| |
Collapse
|
6
|
Mohan BP, Facciorusso A, Khan SR, Chandan S, Kassab LL, Gkolfakis P, Tziatzios G, Triantafyllou K, Adler DG. Real-time computer aided colonoscopy versus standard colonoscopy for improving adenoma detection rate: A meta-analysis of randomized-controlled trials. EClinicalMedicine 2020; 29-30:100622. [PMID: 33294821 PMCID: PMC7691740 DOI: 10.1016/j.eclinm.2020.100622] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Recent prospective randomized controlled trials have evaluated deep convolutional neural network (CNN) based computer aided detection (CADe) of lesions in real-time colonoscopy. We conducted this meta-analysis to compare the adenoma detection rate (ADR) of deep CNN based CADe assisted colonoscopy to standard colonoscopy (SC) from randomized controlled trials (RCTs). METHODS Multiple databases were searched (from inception to May 2020) and parallel RCTs that compared deep CNN based CADe assisted colonoscopy to SC were included for this analysis. Using Mantel-Haenzel (M-H) random effects model, pooled risk ratios (RR) and mean difference (MD) were calculated. In between study heterogeneity was assessed by I2% values. Outcomes assessed included other per patient adenoma parameters. FINDINGS Six RCTs were included in our final analysis that utilized deep CNN based CADe system in real-time colonoscopy. Total numbers of patients assessed were 4962 (2480 in CADe and 2482 in SC group). CADe based colonoscopy demonstrated statistically higher pooled ADR, RR=1.5 (95% CI 1.3-1.72), p<0.0001, I2=56%; and pooled PDR, RR=1.42 (95% CI 1.33-1.51), p<0.00001, I2=9%; when compared to SC. Per patient adenoma detection parameters were significantly better with CADe colonoscopy when compared to SC, with increased scope withdrawal time (mean difference = 0.38, 95% CI 0.05-0.72, p = 0.02). INTERPRETATION Based on our meta-analysis, deep CNN based CADe colonoscopy achieved significantly higher ADR metrics, albeit with increased scope withdrawal time when compared to SC.
Collapse
Affiliation(s)
- Babu P. Mohan
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, University of Foggia, Foggia, Italy
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Shahab R. Khan
- Gastroenterology, Rush University Medical Center, Chicago, IL, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Saurabh Chandan
- Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, MIN, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, 2nd Dep of Internal Medicine – Propaedeutic Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Dep of Internal Medicine – Propaedeutic Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Dep of Internal Medicine – Propaedeutic Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Douglas G. Adler
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
7
|
Hwang JH, Jamidar P, Kyanam Kabir Baig KR, Leung FW, Lightdale JR, Maranki JL, Okolo PI, Swanstrom LL, Chak A. GIE Editorial Board top 10 topics: advances in GI endoscopy in 2019. Gastrointest Endosc 2020; 92:241-251. [PMID: 32470427 DOI: 10.1016/j.gie.2020.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
The American Society for Gastrointestinal Endoscopy's GIE Editorial Board reviewed original endoscopy-related articles published during 2019 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of disinfection, artificial intelligence, bariatric endoscopy, adenoma detection, polypectomy, novel imaging, Barrett's esophagus, third space endoscopy, interventional EUS, and training. This document summarizes these "top 10" endoscopic advances of 2019.
Collapse
Affiliation(s)
- Joo Ha Hwang
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - Priya Jamidar
- Professor of Medicine, Yale University, New Haven, Connecticut
| | | | - Felix W Leung
- Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA
| | - Jennifer R Lightdale
- University of Massachusetts Medical School, Umass Memorial Childrens Medical Center, Worcester, Massachusetts
| | | | - Patrick I Okolo
- Executive Medical Director, Rochester Regional Health Systems, Rochester, NY
| | - Lee L Swanstrom
- Professor of Surgery, Oregon Health and Sciences University: Scientific Director and Chief Innovations Officer, Institutes Hospitalos Universitaires (IHU-Strasbourg) University of Strasbourg
| | - Amitabh Chak
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|