1
|
Seager A, Sharp L, Neilson LJ, Brand A, Hampton JS, Lee TJW, Evans R, Vale L, Whelpton J, Bestwick N, Rees CJ. Polyp detection with colonoscopy assisted by the GI Genius artificial intelligence endoscopy module compared with standard colonoscopy in routine colonoscopy practice (COLO-DETECT): a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9:911-923. [PMID: 39153491 DOI: 10.1016/s2468-1253(24)00161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Increased polyp detection during colonoscopy is associated with decreased post-colonoscopy colorectal cancer incidence and mortality. The COLO-DETECT trial aimed to assess the clinical effectiveness of the GI Genius intelligent endoscopy module for polyp detection, comparing colonoscopy assisted by GI Genius (computer-aided detection [CADe]-assisted colonoscopy) with standard colonoscopy in routine practice. METHODS We did a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial in 12 National Health Service (NHS) hospitals (ten NHS Trusts) in England, among adults (aged ≥18 years) undergoing planned colonoscopy for gastrointestinal symptoms or for surveillance due to personal or family history (ie, symptomatic indications), or colorectal cancer screening. Randomisation (1:1) to CADe-assisted colonoscopy or standard colonoscopy was done with a web-based dynamic adaptive algorithm, immediately before colonoscopy, with stratification by age group, sex, colonoscopy indication (screening or symptomatic), and NHS Trust. Recruiting staff, participants, and colonoscopists were unmasked to trial allocation; histopathologists, co-chief investigators, and trial statisticians were masked. CADe-assisted colonoscopy consisted of standard colonoscopy plus the GI Genius module active for at least the entire inspection phase of colonoscope withdrawal. The primary outcome was mean adenomas per procedure (total number of adenomas detected divided by total number of procedures); the key secondary outcome was adenoma detection rate (proportion of colonoscopies with at least one adenoma). Analysis was by intention to treat (ITT), with outcomes compared between groups by mixed-effects regression modelling, in which effect estimates were adjusted for randomisation stratification variables. Data were imputed for outcome measures with more than 5% missing values. All participants who underwent colonoscopy were assessed for safety. The trial is registered on ISRCTN (ISRCTN10451355) and ClinicalTrials.gov (NCT04723758), and is complete. FINDINGS Between March 29, 2021, and April 6, 2023, 2032 participants (1132 [55·7%] male, 900 [44·3%] female; mean age 62·4 years [SD 10·8]) were recruited and randomly assigned: 1015 to CADe-assisted colonoscopy and 1017 to standard colonoscopy. 1231 (60·6%) participants were undergoing screening and 801 (39·4%) had symptomatic indications. Mean adenomas per procedure was 1·56 (SD 2·82; n=1001 participants with available data) in the CADe-assisted colonoscopy group versus 1·21 (1·91; n=1009) in the standard colonoscopy group, representing an adjusted mean difference of 0·36 (95% CI 0·14-0·57; adjusted incidence rate ratio 1·30 [95% CI 1·15-1·47], p<0·0001). Adenomas were detected in 555 (56·6%) of 980 participants in the CADe-assisted colonoscopy group versus 477 (48·4%) of 986 in the standard colonoscopy group, representing a proportion difference of 8·3% (95% CI 3·9-12·7; adjusted odds ratio 1·47 [95% CI 1·21-1·78], p<0·0001). Numbers of adverse events were similar between the CADe-assisted colonoscopy and standard colonoscopy groups (adverse events: 25 vs 19; serious adverse events: four vs six), and no adverse events in the CADe-assisted colonoscopy group were deemed to be related to GI Genius use on independent review. INTERPRETATION Results of the COLO-DETECT trial support the use of GI Genius to increase detection of premalignant colorectal polyps in routine colonoscopy practice. FUNDING Medtronic.
Collapse
Affiliation(s)
- Alexander Seager
- Department of Research and Innovation, South Tyneside and Sunderland NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK; Population Health Sciences Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Laura J Neilson
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK; Population Health Sciences Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Andrew Brand
- North Wales Organisation for Randomised Trials in Health, Clinical Trials Unit, Bangor University, Bangor, UK
| | - James S Hampton
- Department of Research and Innovation, South Tyneside and Sunderland NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK; Population Health Sciences Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Tom J W Lee
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Department of Gastroenterology, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Rachel Evans
- North Wales Organisation for Randomised Trials in Health, Clinical Trials Unit, Bangor University, Bangor, UK
| | - Luke Vale
- Newcastle University-Health Economics Group, Population Health Sciences Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Nathania Bestwick
- Department of Research and Innovation, South Tyneside and Sunderland NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK; Population Health Sciences Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Bowel Cancer UK, London, UK
| | - Colin J Rees
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK; Population Health Sciences Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
| |
Collapse
|
2
|
Mandarino FV, Danese S, Uraoka T, Parra-Blanco A, Maeda Y, Saito Y, Kudo SE, Bourke MJ, Iacucci M. Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy. Dig Endosc 2024; 36:761-777. [PMID: 37988279 DOI: 10.1111/den.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/19/2023] [Indexed: 11/23/2023]
Abstract
Precision endoscopy in the management of colorectal polyps and early colorectal cancer has emerged as the standard of care. It includes optical characterization of polyps and estimation of submucosal invasion depth of large nonpedunculated colorectal polyps to select the appropriate endoscopic resection modality. Over time, several imaging modalities have been implemented in endoscopic practice to improve optical performance. Among these, image-enhanced endoscopy systems and magnification endoscopy represent now well-established tools. New advanced technologies, such as endocytoscopy and confocal laser endomicroscopy, have recently shown promising results in predicting the histology of colorectal polyps. In recent years, artificial intelligence has continued to enhance endoscopic performance in the characterization of colorectal polyps, overcoming the limitations of other imaging modes. In this review we retrace the path of precision endoscopy, analyzing the yield of various endoscopic imaging techniques in personalizing management of colorectal polyps and early colorectal cancer.
Collapse
Affiliation(s)
- Francesco Vito Mandarino
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Hospital IRCSS, Milan, Italy
- Department of Gastrointestinal Endoscopy, Westmead Hospital, Sydney, NSW, Australia
| | - Silvio Danese
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Hospital IRCSS, Milan, Italy
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gumma, Japan
| | - Adolfo Parra-Blanco
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Michael J Bourke
- Department of Gastrointestinal Endoscopy, Westmead Hospital, Sydney, NSW, Australia
| | - Marietta Iacucci
- Department of Gastroenterology, University College Cork, Cork, Ireland
| |
Collapse
|
3
|
Tiankanon K, Aniwan S, Kerr SJ, Mekritthikrai K, Kongtab N, Wisedopas N, Piyachaturawat P, Kulpatcharapong S, Linlawan S, Phromnil P, Muangpaisarn P, Orprayoon T, Chanyaswad J, Sunthornwechapong P, Vateekul P, Kullavanijaya P, Rerknimitr R. Improvement of adenoma detection rate by two computer-aided colonic polyp detection systems in high adenoma detectors: a randomized multicenter trial. Endoscopy 2024; 56:273-282. [PMID: 37963587 DOI: 10.1055/a-2210-7999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND This study aimed to evaluate the benefits of a self-developed computer-aided polyp detection system (SD-CADe) and a commercial system (CM-CADe) for high adenoma detectors compared with white-light endoscopy (WLE) as a control. METHODS Average-risk 50-75-year-old individuals who underwent screening colonoscopy at five referral centers were randomized to SD-CADe, CM-CADe, or WLE groups (1:1:1 ratio). Trainees and staff with an adenoma detection rate (ADR) of ≥35% were recruited. The primary outcome was ADR. Secondary outcomes were the proximal adenoma detection rate (pADR), advanced adenoma detection rate (AADR), and the number of adenomas, proximal adenomas, and advanced adenomas per colonoscopy (APC, pAPC, and AAPC, respectively). RESULTS The study enrolled 1200 participants. The ADR in the control, CM-CADe, and SD-CADe groups was 38.3%, 50.0%, and 54.8%, respectively. The pADR was 23.0%, 32.3%, and 38.8%, respectively. AADR was 6.0%, 10.3%, and 9.5%, respectively. After adjustment, the ADR and pADR in both intervention groups were significantly higher than in controls (all P<0.05). The APC in the control, CM-CADe, and SD-CADe groups was 0.66, 1.04, and 1.16, respectively. The pAPC was 0.33, 0.53, and 0.64, respectively, and the AAPC was 0.07, 0.12, and 0.10, respectively. Both CADe systems showed significantly higher APC and pAPC than WLE. AADR and AAPC were improved in both CADe groups versus control, although the differences were not statistically significant. CONCLUSION Even in high adenoma detectors, CADe significantly improved ADR and APC. The AADR tended to be higher with both systems, and this may enhance colorectal cancer prevention.
Collapse
Affiliation(s)
- Kasenee Tiankanon
- Division of Gastroenterology, Chulalongkorn University, Bangkok, Thailand
- Gastrointestinal Endoscopy Excellence Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Satimai Aniwan
- Division of Gastroenterology, Chulalongkorn University, Bangkok, Thailand
- Gastrointestinal Endoscopy Excellence Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Stephen J Kerr
- Biostatistics Excellence Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Krittaya Mekritthikrai
- Division of Gastroenterology, Chulalongkorn University, Bangkok, Thailand
- Gastrointestinal Endoscopy Excellence Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Natanong Kongtab
- Division of Gastroenterology, Chulalongkorn University, Bangkok, Thailand
- Gastrointestinal Endoscopy Excellence Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Naruemon Wisedopas
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | - Poonrada Phromnil
- Department of Medicine, Khlong Khlung Hospital, Kamphaeng Phet, Thailand
| | - Puth Muangpaisarn
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Prapokklao Hospital, Chanthaburi, Thailand
| | - Theerapat Orprayoon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Prapokklao Hospital, Chanthaburi, Thailand
| | - Jaruwan Chanyaswad
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Prapokklao Hospital, Chanthaburi, Thailand
| | | | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Pinit Kullavanijaya
- Division of Gastroenterology, Chulalongkorn University, Bangkok, Thailand
- Gastrointestinal Endoscopy Excellence Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Chulalongkorn University, Bangkok, Thailand
- Gastrointestinal Endoscopy Excellence Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| |
Collapse
|
4
|
Tiankanon K, Karuehardsuwan J, Aniwan S, Mekaroonkamol P, Sunthornwechapong P, Navadurong H, Tantitanawat K, Mekritthikrai K, Samutrangsi S, Vateekul P, Rerknimitr R. Performance comparison between two computer-aided detection colonoscopy models by trainees using different false positive thresholds: a cross-sectional study in Thailand. Clin Endosc 2024; 57:217-225. [PMID: 38556473 PMCID: PMC10984740 DOI: 10.5946/ce.2023.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND/AIMS This study aims to compare polyp detection performance of "Deep-GI," a newly developed artificial intelligence (AI) model, to a previously validated AI model computer-aided polyp detection (CADe) using various false positive (FP) thresholds and determining the best threshold for each model. METHODS Colonoscopy videos were collected prospectively and reviewed by three expert endoscopists (gold standard), trainees, CADe (CAD EYE; Fujifilm Corp.), and Deep-GI. Polyp detection sensitivity (PDS), polyp miss rates (PMR), and false-positive alarm rates (FPR) were compared among the three groups using different FP thresholds for the duration of bounding boxes appearing on the screen. RESULTS In total, 170 colonoscopy videos were used in this study. Deep-GI showed the highest PDS (99.4% vs. 85.4% vs. 66.7%, p<0.01) and the lowest PMR (0.6% vs. 14.6% vs. 33.3%, p<0.01) when compared to CADe and trainees, respectively. Compared to CADe, Deep-GI demonstrated lower FPR at FP thresholds of ≥0.5 (12.1 vs. 22.4) and ≥1 second (4.4 vs. 6.8) (both p<0.05). However, when the threshold was raised to ≥1.5 seconds, the FPR became comparable (2 vs. 2.4, p=0.3), while the PMR increased from 2% to 10%. CONCLUSION Compared to CADe, Deep-GI demonstrated a higher PDS with significantly lower FPR at ≥0.5- and ≥1-second thresholds. At the ≥1.5-second threshold, both systems showed comparable FPR with increased PMR.
Collapse
Affiliation(s)
- Kasenee Tiankanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Julalak Karuehardsuwan
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Satimai Aniwan
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Parit Mekaroonkamol
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | | | - Huttakan Navadurong
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Kittithat Tantitanawat
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Krittaya Mekritthikrai
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Salin Samutrangsi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai red cross, Bangkok, Thailand
| |
Collapse
|
5
|
Aziz M, Haghbin H, Sayeh W, Alfatlawi H, Gangwani MK, Sohail AH, Zahdeh T, Weissman S, Kamal F, Lee-Smith W, Nawras A, Sharma P, Shaukat A. Comparison of Artificial Intelligence With Other Interventions to Improve Adenoma Detection Rate for Colonoscopy: A Network Meta-analysis. J Clin Gastroenterol 2024; 58:143-155. [PMID: 36441163 DOI: 10.1097/mcg.0000000000001813] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/26/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Recent randomized controlled trials (RCTs) and meta-analysis have demonstrated improved adenoma detection rate (ADR) for colonoscopy with artificial intelligence (AI) compared with high-definition (HD) colonoscopy without AI. We aimed to perform a systematic review and network meta-analysis of all RCTs to assess the impact of AI compared with other endoscopic interventions aimed at increasing ADR such as distal attachment devices, dye-based/virtual chromoendoscopy, water-based techniques, and balloon-assisted devices. METHODS A comprehensive literature search of PubMed/Medline, Embase, and Cochrane was performed through May 6, 2022, to include RCTs comparing ADR for any endoscopic intervention mentioned above. Network meta-analysis was conducted using a frequentist approach and random effects model. Relative risk (RR) and 95% CI were calculated for proportional outcome. RESULTS A total of 94 RCTs with 61,172 patients (mean age 59.1±5.2 y, females 45.8%) and 20 discrete study interventions were included. Network meta-analysis demonstrated significantly improved ADR for AI compared with autofluorescence imaging (RR: 1.33, CI: 1.06 to 1.66), dye-based chromoendoscopy (RR: 1.22, CI: 1.06 to 1.40), endocap (RR: 1.32, CI: 1.17 to 1.50), endocuff (RR: 1.19, CI: 1.04 to 1.35), endocuff vision (RR: 1.26, CI: 1.13 to 1.41), endoring (RR: 1.30, CI: 1.10 to 1.52), flexible spectral imaging color enhancement (RR: 1.26, CI: 1.09 to 1.46), full-spectrum endoscopy (RR: 1.40, CI: 1.19 to 1.65), HD (RR: 1.41, CI: 1.28 to 1.54), linked color imaging (RR: 1.21, CI: 1.08 to 1.36), narrow band imaging (RR: 1.33, CI: 1.18 to 1.48), water exchange (RR: 1.22, CI: 1.06 to 1.42), and water immersion (RR: 1.47, CI: 1.19 to 1.82). CONCLUSIONS AI demonstrated significantly improved ADR when compared with most endoscopic interventions. Future RCTs directly assessing these associations are encouraged.
Collapse
Affiliation(s)
| | - Hossein Haghbin
- Department of Gastroenterology, Ascension Providence Southfield, Southfield, MI
| | | | | | | | - Amir H Sohail
- Department of Surgery, New York University Langone Health, Long Island
| | - Tamer Zahdeh
- Department of Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Simcha Weissman
- Department of Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Faisal Kamal
- Department of Gastroenterology, University of California San Francisco, San Francisco, CA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH
| | - Ali Nawras
- Departments of Gastroenterology and Hepatology
| | - Prateek Sharma
- Digestive Endoscopy Unit, Kansas City VA Medical Center, Kansas City, MO
| | - Aasma Shaukat
- Department of Gastroenterology, NYU Grossman School of Medicine, New York, NY
| |
Collapse
|
6
|
Lou S, Du F, Song W, Xia Y, Yue X, Yang D, Cui B, Liu Y, Han P. Artificial intelligence for colorectal neoplasia detection during colonoscopy: a systematic review and meta-analysis of randomized clinical trials. EClinicalMedicine 2023; 66:102341. [PMID: 38078195 PMCID: PMC10698672 DOI: 10.1016/j.eclinm.2023.102341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 05/11/2024] Open
Abstract
BACKGROUND The use of artificial intelligence (AI) in detecting colorectal neoplasia during colonoscopy holds the potential to enhance adenoma detection rates (ADRs) and reduce adenoma miss rates (AMRs). However, varied outcomes have been observed across studies. Thus, this study aimed to evaluate the potential advantages and disadvantages of employing AI-aided systems during colonoscopy. METHODS Using Medical Subject Headings (MeSH) terms and keywords, a comprehensive electronic literature search was performed of the Embase, Medline, and the Cochrane Library databases from the inception of each database until October 04, 2023, in order to identify randomized controlled trials (RCTs) comparing AI-assisted with standard colonoscopy for detecting colorectal neoplasia. Primary outcomes included AMR, ADR, and adenomas detected per colonoscopy (APC). Secondary outcomes comprised the poly missed detection rate (PMR), poly detection rate (PDR), and poly detected per colonoscopy (PPC). We utilized random-effects meta-analyses with Hartung-Knapp adjustment to consolidate results. The prediction interval (PI) and I2 statistics were utilized to quantify between-study heterogeneity. Moreover, meta-regression and subgroup analyses were performed to investigate the potential sources of heterogeneity. This systematic review and meta-analysis is registered with PROSPERO (CRD42023428658). FINDINGS This study encompassed 33 trials involving 27,404 patients. Those undergoing AI-aided colonoscopy experienced a significant decrease in PMR (RR, 0.475; 95% CI, 0.294-0.768; I2 = 87.49%) and AMR (RR, 0.495; 95% CI, 0.390-0.627; I2 = 48.76%). Additionally, a significant increase in PDR (RR, 1.238; 95% CI, 1.158-1.323; I2 = 81.67%) and ADR (RR, 1.242; 95% CI, 1.159-1.332; I2 = 78.87%), along with a significant increase in the rates of PPC (IRR, 1.388; 95% CI, 1.270-1.517; I2 = 91.99%) and APC (IRR, 1.390; 95% CI, 1.277-1.513; I2 = 86.24%), was observed. This resulted in 0.271 more PPCs (95% CI, 0.144-0.259; I2 = 65.61%) and 0.202 more APCs (95% CI, 0.144-0.259; I2 = 68.15%). INTERPRETATION AI-aided colonoscopy significantly enhanced the detection of colorectal neoplasia detection, likely by reducing the miss rate. However, future studies should focus on evaluating the cost-effectiveness and long-term benefits of AI-aided colonoscopy in reducing cancer incidence. FUNDING This work was supported by the Heilongjiang Provincial Natural Science Foundation of China (LH2023H096), the Postdoctoral research project in Heilongjiang Province (LBH-Z22210), the National Natural Science Foundation of China's General Program (82072640) and the Outstanding Youth Project of Heilongjiang Natural Science Foundation (YQ2021H023).
Collapse
Affiliation(s)
- Shenghan Lou
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Fenqi Du
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Wenjie Song
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Yixiu Xia
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Xinyu Yue
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Da Yang
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Binbin Cui
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Yanlong Liu
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Peng Han
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
- Key Laboratory of Tumor Immunology in Heilongjiang, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| |
Collapse
|
7
|
Young E, Edwards L, Singh R. The Role of Artificial Intelligence in Colorectal Cancer Screening: Lesion Detection and Lesion Characterization. Cancers (Basel) 2023; 15:5126. [PMID: 37958301 PMCID: PMC10647850 DOI: 10.3390/cancers15215126] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/14/2023] [Indexed: 11/15/2023] Open
Abstract
Colorectal cancer remains a leading cause of cancer-related morbidity and mortality worldwide, despite the widespread uptake of population surveillance strategies. This is in part due to the persistent development of 'interval colorectal cancers', where patients develop colorectal cancer despite appropriate surveillance intervals, implying pre-malignant polyps were not resected at a prior colonoscopy. Multiple techniques have been developed to improve the sensitivity and accuracy of lesion detection and characterisation in an effort to improve the efficacy of colorectal cancer screening, thereby reducing the incidence of interval colorectal cancers. This article presents a comprehensive review of the transformative role of artificial intelligence (AI), which has recently emerged as one such solution for improving the quality of screening and surveillance colonoscopy. Firstly, AI-driven algorithms demonstrate remarkable potential in addressing the challenge of overlooked polyps, particularly polyp subtypes infamous for escaping human detection because of their inconspicuous appearance. Secondly, AI empowers gastroenterologists without exhaustive training in advanced mucosal imaging to characterise polyps with accuracy similar to that of expert interventionalists, reducing the dependence on pathologic evaluation and guiding appropriate resection techniques or referrals for more complex resections. AI in colonoscopy holds the potential to advance the detection and characterisation of polyps, addressing current limitations and improving patient outcomes. The integration of AI technologies into routine colonoscopy represents a promising step towards more effective colorectal cancer screening and prevention.
Collapse
Affiliation(s)
- Edward Young
- Faculty of Health and Medical Sciences, University of Adelaide, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Australia
| | - Louisa Edwards
- Faculty of Health and Medical Sciences, University of Adelaide, Queen Elizabeth Hospital, Port Rd, Woodville South, SA 5011, Australia
| | - Rajvinder Singh
- Faculty of Health and Medical Sciences, University of Adelaide, Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, SA 5112, Australia
| |
Collapse
|
8
|
Aziz M, Haghbin H, Gangwani MK, Nawras M, Nawras Y, Dahiya DS, Sohail AH, Lee-Smith W, Kamal F, Shaukat A. 9-Minute Withdrawal Time Improves Adenoma Detection Rate Compared With 6-Minute Withdrawal Time During Colonoscopy: A Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol 2023; 57:863-870. [PMID: 37389958 DOI: 10.1097/mcg.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Adenoma detection rate (ADR) is a quality metric that has been emphasized by multiple societies as improved ADR leads to reduced interval colorectal cancer (CRC). It is postulated that increased withdrawal time (WT) can lead to higher ADR. Multiple randomized controlled trials (RCTs) were undertaken to evaluate this. We performed a systematic review and meta-analysis of RCTs to analyze the impact of higher WT on ADR during colonoscopy. METHODS The following databases were comprehensively searched through November 8, 2022: Embase, MEDLINE, Cochrane, Web of Science, and Google Scholar. Only RCTs were eligible for inclusion. We applied the random effects model using the DerSimonian Laird approach and calculated risk ratio (RR) for binary outcomes and mean difference (MD) for continuous outcomes. 95% CI and P values were generated. RESULTS A total of 3 RCTs with 2159 patients were included of which 1136 patients were included in the 9-minute withdrawal group (9WT) and 1023 patients in the 6-minute withdrawal group (6WT). The mean age range was 53.6 to 56.8 years and the male gender was 50.7%. The overall ADR was significantly higher for 9WT (RR=1.23; 95% CI, 1.09-1.40; P <0.001). The overall adenoma per colonoscopy (APC) was also higher for the 9WT group (MD: 0.14; 95% CI, 0.04-0.25; P =0.008). CONCLUSION The 9-minute withdrawal time improved ADR and APC compared with the 6-minute withdrawal. Given the high-quality evidence, we recommend that clinicians at least perform a 9-minute withdrawal to achieve higher quality metrics including ADR to reduce interval CRC.
Collapse
Affiliation(s)
| | - Hossein Haghbin
- Division of Gastroenterology, Ascension Providence Southfield, Southfield
| | | | | | | | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI
| | | | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH
| | - Faisal Kamal
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA
| | - Aasma Shaukat
- Division of Gastroenterology, NYU Langone Health, New York, NY
| |
Collapse
|
9
|
Galati JS, Lin K, Gross SA. Recent advances in devices and technologies that might prove revolutionary for colonoscopy procedures. Expert Rev Med Devices 2023; 20:1087-1103. [PMID: 37934873 DOI: 10.1080/17434440.2023.2280773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common malignancy and second leading cause of cancer-related mortality in the world. Adenoma detection rate (ADR), a quality indicator for colonoscopy, has gained prominence as it is inversely related to CRC incidence and mortality. As such, recent efforts have focused on developing novel colonoscopy devices and technologies to improve ADR. AREAS COVERED The main objective of this paper is to provide an overview of advancements in the fields of colonoscopy mechanical attachments, artificial intelligence-assisted colonoscopy, and colonoscopy optical enhancements with respect to ADR. We accomplished this by performing a comprehensive search of multiple electronic databases from inception to September 2023. This review is intended to be an introduction to colonoscopy devices and technologies. EXPERT OPINION Numerous mechanical attachments and optical enhancements have been developed that have the potential to improve ADR and AI has gone from being an inaccessible concept to a feasible means for improving ADR. While these advances are exciting and portend a change in what will be considered standard colonoscopy, they continue to require refinement. Future studies should focus on combining modalities to further improve ADR and exploring the use of these technologies in other facets of colonoscopy.
Collapse
Affiliation(s)
- Jonathan S Galati
- Department of Internal Medicine, NYU Langone Health, New York, NY, USA
| | - Kevin Lin
- Department of Internal Medicine, NYU Langone Health, New York, NY, USA
| | - Seth A Gross
- Division of Gastroenterology, NYU Langone Health, New York, NY, USA
| |
Collapse
|
10
|
Mehta A, Kumar H, Yazji K, Wireko AA, Sivanandan Nagarajan J, Ghosh B, Nahas A, Morales Ojeda L, Anand A, Sharath M, Huang H, Garg T, Isik A. Effectiveness of artificial intelligence-assisted colonoscopy in early diagnosis of colorectal cancer: a systematic review. Int J Surg 2023; 109:946-952. [PMID: 36917126 PMCID: PMC10389330 DOI: 10.1097/js9.0000000000000285] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION As artificial intelligence (AI)-assisted diagnosis gained immense popularity, it is imperative to consider its utility and efficiency in the early diagnosis of colorectal cancer (CRC), responsible for over 1.8 million cases and 881 000 deaths globally, as reported in 2018. Improved adenoma detection rate, as well as better characterizations of polyps, are significant advantages of AI-assisted colonoscopy (AIC). This systematic review (SR) investigates the effectiveness of AIC in the early diagnosis of CRC as compared to conventional colonoscopy. MATERIALS AND METHODS Electronic databases such as PubMed/Medline, SCOPUS, and Web of Science were reviewed for original studies (randomized controlled trials, observational studies), SRs, and meta-analysis between 2017 and 2022 utilizing Medical Subject Headings terminology in a broad search strategy. All searches were performed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and were conducted from November 2022. A data extraction form based on the Cochrane Consumers and Communication Review group's extraction template for quality assessment and evidence synthesis was used for data extraction. All included studies considered for bias and ethical criteria and provided valuable evidence to answer the research question. RESULTS The database search identified 218 studies, including 87 from PubMed, 60 from SCOPUS, and 71 from Web of Science databases. The retrieved studies from the databases were imported to Rayyan software and a duplicate article check was performed, all duplicate articles were removed after careful evaluation of the data. The abstract and full-text screening was performed in accordance with the following eligibility criteria: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational studies; Preferred Reporting Items for Systematic Reviews and Meta-Analysis for review articles, ENTREQ for narrative studies; and modified JADAD for randomized controlled trials. This yielded 15 studies that met the requirements for this SR and were finally included in the review. CONCLUSION AIC is a safe, highly effective screening tool that can increase the detection rate of adenomas, and polyps resulting in an early diagnosis of CRC in adults when compared to conventional colonoscopy. The results of this SR prompt further large-scale research to investigate the effectiveness in accordance with sex, race, and socioeconomic status, as well as its influence on prognosis and survival rate.
Collapse
Affiliation(s)
- Aashna Mehta
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Katia Yazji
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Bikona Ghosh
- Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Ahmad Nahas
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Luis Morales Ojeda
- Institute of Urology, University of Southern California, Los Angeles California, USA
| | - Ayush Anand
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Medha Sharath
- Bangalore Medical College and Research Institute, Bangalore, Karnataka
| | - Helen Huang
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tulika Garg
- Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Arda Isik
- Department of General Surgery, Istanbul Medeniyet University, Istanbul, Turkey
| |
Collapse
|
11
|
Zimmermann-Fraedrich K, Rösch T. Artificial intelligence and the push for small adenomas: all we need? Endoscopy 2023; 55:320-323. [PMID: 36882088 DOI: 10.1055/a-2038-7078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
12
|
Eysenbach G, Liu SHK, Leung K, Wu JT, Zauber AG, Leung WK. The Impacts of Computer-Aided Detection of Colorectal Polyps on Subsequent Colonoscopy Surveillance Intervals: Simulation Study. J Med Internet Res 2023; 25:e42665. [PMID: 36763451 PMCID: PMC9960036 DOI: 10.2196/42665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Computer-aided detection (CADe) of colorectal polyps has been shown to increase adenoma detection rates, which would potentially shorten subsequent surveillance intervals. OBJECTIVE The purpose of this study is to simulate the potential changes in subsequent colonoscopy surveillance intervals after the application of CADe in a large cohort of patients. METHODS We simulated the projected increase in polyp and adenoma detection by universal CADe application in our patients who had undergone colonoscopy with complete endoscopic and histological findings between 2016 and 2020. The simulation was based on bootstrapping the published performance of CADe. The corresponding changes in surveillance intervals for each patient, as recommended by the US Multi-Society Task Force on Colorectal Cancer (USMSTF) or the European Society of Gastrointestinal Endoscopy (ESGE), were determined after the CADe was determined. RESULTS A total of 3735 patients who had undergone colonoscopy were included. Based on the simulated CADe effect, the application of CADe would result in 19.1% (n=714) and 1.9% (n=71) of patients having shorter surveillance intervals, according to the USMSTF and ESGE guidelines, respectively. In particular, all (or 2.7% (n=101) of the total) patients who were originally scheduled to have 3-5 years of surveillance would have their surveillance intervals shortened to 3 years, following the USMSTF guidelines. The changes in this group of patients were largely attributed to an increase in the number of adenomas (n=75, 74%) rather than serrated lesions being detected. CONCLUSIONS Widespread adoption of CADe would inevitably increase the demand for surveillance colonoscopies with the shortening of original surveillance intervals, particularly following the current USMSTF guideline.
Collapse
Affiliation(s)
| | - Sze Hang Kevin Liu
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kathy Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Wai Keung Leung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
13
|
Galati JS, Duve RJ, O'Mara M, Gross SA. Artificial intelligence in gastroenterology: A narrative review. Artif Intell Gastroenterol 2022; 3:117-141. [DOI: 10.35712/aig.v3.i5.117] [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] [Received: 10/09/2022] [Revised: 11/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Artificial intelligence (AI) is a complex concept, broadly defined in medicine as the development of computer systems to perform tasks that require human intelligence. It has the capacity to revolutionize medicine by increasing efficiency, expediting data and image analysis and identifying patterns, trends and associations in large datasets. Within gastroenterology, recent research efforts have focused on using AI in esophagogastroduodenoscopy, wireless capsule endoscopy (WCE) and colonoscopy to assist in diagnosis, disease monitoring, lesion detection and therapeutic intervention. The main objective of this narrative review is to provide a comprehensive overview of the research being performed within gastroenterology on AI in esophagogastroduodenoscopy, WCE and colonoscopy.
Collapse
Affiliation(s)
- Jonathan S Galati
- Department of Medicine, NYU Langone Health, New York, NY 10016, United States
| | - Robert J Duve
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, United States
| | - Matthew O'Mara
- Division of Gastroenterology, NYU Langone Health, New York, NY 10016, United States
| | - Seth A Gross
- Division of Gastroenterology, NYU Langone Health, New York, NY 10016, United States
| |
Collapse
|
14
|
Young EJ, Rajandran A, Philpott HL, Sathananthan D, Hoile SF, Singh R. Mucosal imaging in colon polyps: New advances and what the future may hold. World J Gastroenterol 2022; 28:6632-6661. [PMID: 36620337 PMCID: PMC9813932 DOI: 10.3748/wjg.v28.i47.6632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/23/2022] [Accepted: 11/23/2022] [Indexed: 12/19/2022] Open
Abstract
An expanding range of advanced mucosal imaging technologies have been developed with the goal of improving the detection and characterization of lesions in the gastrointestinal tract. Many technologies have targeted colorectal neoplasia given the potential for intervention prior to the development of invasive cancer in the setting of widespread surveillance programs. Improvement in adenoma detection reduces miss rates and prevents interval cancer development. Advanced imaging technologies aim to enhance detection without significantly increasing procedural time. Accurate polyp characterisation guides resection techniques for larger polyps, as well as providing the platform for the “resect and discard” and “do not resect” strategies for small and diminutive polyps. This review aims to collate and summarise the evidence regarding these technologies to guide colonoscopic practice in both interventional and non-interventional endoscopists.
Collapse
Affiliation(s)
- Edward John Young
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Arvinf Rajandran
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
| | - Hamish Lachlan Philpott
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Dharshan Sathananthan
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Sophie Fenella Hoile
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| |
Collapse
|
15
|
Martinez-Millana A, Saez-Saez A, Tornero-Costa R, Azzopardi-Muscat N, Traver V, Novillo-Ortiz D. Artificial intelligence and its impact on the domains of universal health coverage, health emergencies and health promotion: An overview of systematic reviews. Int J Med Inform 2022; 166:104855. [PMID: 35998421 PMCID: PMC9551134 DOI: 10.1016/j.ijmedinf.2022.104855] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Artificial intelligence is fueling a new revolution in medicine and in the healthcare sector. Despite the growing evidence on the benefits of artificial intelligence there are several aspects that limit the measure of its impact in people's health. It is necessary to assess the current status on the application of AI towards the improvement of people's health in the domains defined by WHO's Thirteenth General Programme of Work (GPW13) and the European Programme of Work (EPW), to inform about trends, gaps, opportunities, and challenges. OBJECTIVE To perform a systematic overview of systematic reviews on the application of artificial intelligence in the people's health domains as defined in the GPW13 and provide a comprehensive and updated map on the application specialties of artificial intelligence in terms of methodologies, algorithms, data sources, outcomes, predictors, performance, and methodological quality. METHODS A systematic search in MEDLINE, EMBASE, Cochrane and IEEEXplore was conducted between January 2015 and June 2021 to collect systematic reviews using a combination of keywords related to the domains of universal health coverage, health emergencies protection, and better health and wellbeing as defined by the WHO's PGW13 and EPW. Eligibility criteria was based on methodological quality and the inclusion of practical implementation of artificial intelligence. Records were classified and labeled using ICD-11 categories into the domains of the GPW13. Descriptors related to the area of implementation, type of modeling, data entities, outcomes and implementation on care delivery were extracted using a structured form and methodological aspects of the included reviews studies was assessed using the AMSTAR checklist. RESULTS The search strategy resulted in the screening of 815 systematic reviews from which 203 were assessed for eligibility and 129 were included in the review. The most predominant domain for artificial intelligence applications was Universal Health Coverage (N = 98) followed by Health Emergencies (N = 16) and Better Health and Wellbeing (N = 15). Neoplasms area on Universal Health Coverage was the disease area featuring most of the applications (21.7 %, N = 28). The reviews featured analytics primarily over both public and private data sources (67.44 %, N = 87). The most used type of data was medical imaging (31.8 %, N = 41) and predictors based on regions of interest and clinical data. The most prominent subdomain of Artificial Intelligence was Machine Learning (43.4 %, N = 56), in which Support Vector Machine method was predominant (20.9 %, N = 27). Regarding the purpose, the application of Artificial Intelligence I is focused on the prediction of the diseases (36.4 %, N = 47). With respect to the validation, more than a half of the reviews (54.3 %, N = 70) did not report a validation procedure and, whenever available, the main performance indicator was the accuracy (28.7 %, N = 37). According to the methodological quality assessment, a third of the reviews (34.9 %, N = 45) implemented methods for analysis the risk of bias and the overall AMSTAR score below was 5 (4.01 ± 1.93) on all the included systematic reviews. CONCLUSION Artificial intelligence is being used for disease modelling, diagnose, classification and prediction in the three domains of GPW13. However, the evidence is often limited to laboratory and the level of adoption is largely unbalanced between ICD-11 categoriesand diseases. Data availability is a determinant factor on the developmental stage of artificial intelligence applications. Most of the reviewed studies show a poor methodological quality and are at high risk of bias, which limits the reproducibility of the results and the reliability of translating these applications to real clinical scenarios. The analyzed papers show results only in laboratory and testing scenarios and not in clinical trials nor case studies, limiting the supporting evidence to transfer artificial intelligence to actual care delivery.
Collapse
Affiliation(s)
- Antonio Martinez-Millana
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Camino de Vera S/N, Valencia 46022, Spain
| | - Aida Saez-Saez
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Camino de Vera S/N, Valencia 46022, Spain
| | - Roberto Tornero-Costa
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Camino de Vera S/N, Valencia 46022, Spain
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Vicente Traver
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València, Camino de Vera S/N, Valencia 46022, Spain
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark.
| |
Collapse
|
16
|
Ortiz Zúñiga O, Fernández Esparrach MG, Daca M, Pellisé M. Artificial intelligence in gastrointestinal endoscopy - Evolution to a new era. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:605-615. [PMID: 35770604 DOI: 10.17235/reed.2022.8961/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Artificial intelligence (AI) systems based on machine learning have evolved in the last few years with an increasing applicability in gastrointestinal endoscopy. Thanks to AI, an image (input) can be transformed into a clinical decision (output). Although AI systems have been initially studied to improve detection (CADe) and characterization of colorectal lesions (CADx), other indications are being currently investigated as detection of blind spots, scope guidance, or delineation/measurement of lesions. The objective of these review is to summarize the current evidence on applicability of AI systems in gastrointestinal endoscopy, highlight strengths and limitations of the technology and review regulatory and ethical aspects for its general implementation in gastrointestinal endoscopy.
Collapse
Affiliation(s)
| | | | - María Daca
- Gastroenterología, Hospital Clínic Barcelona, España
| | - María Pellisé
- Gastroenterología, Hospital Clínic Barcelona, España
| |
Collapse
|
17
|
Reverberi C, Rigon T, Solari A, Hassan C, Cherubini P, Cherubini A. Experimental evidence of effective human-AI collaboration in medical decision-making. Sci Rep 2022; 12:14952. [PMID: 36056152 PMCID: PMC9440124 DOI: 10.1038/s41598-022-18751-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Artificial Intelligence (AI) systems are precious support for decision-making, with many applications also in the medical domain. The interaction between MDs and AI enjoys a renewed interest following the increased possibilities of deep learning devices. However, we still have limited evidence-based knowledge of the context, design, and psychological mechanisms that craft an optimal human-AI collaboration. In this multicentric study, 21 endoscopists reviewed 504 videos of lesions prospectively acquired from real colonoscopies. They were asked to provide an optical diagnosis with and without the assistance of an AI support system. Endoscopists were influenced by AI ([Formula: see text]), but not erratically: they followed the AI advice more when it was correct ([Formula: see text]) than incorrect ([Formula: see text]). Endoscopists achieved this outcome through a weighted integration of their and the AI opinions, considering the case-by-case estimations of the two reliabilities. This Bayesian-like rational behavior allowed the human-AI hybrid team to outperform both agents taken alone. We discuss the features of the human-AI interaction that determined this favorable outcome.
Collapse
Affiliation(s)
- Carlo Reverberi
- Department of Psychology, University of Milano-Bicocca, 20126, Milan, Italy.
- Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milan, Italy.
| | - Tommaso Rigon
- Department of Economics, Management and Statistics, University of Milano-Bicocca, 20126, Milan, Italy
| | - Aldo Solari
- Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milan, Italy
- Department of Economics, Management and Statistics, University of Milano-Bicocca, 20126, Milan, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Paolo Cherubini
- Department of Psychology, University of Milano-Bicocca, 20126, Milan, Italy
- Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milan, Italy
- Department of Neural and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Andrea Cherubini
- Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milan, Italy.
- Artificial Intelligence Group, Cosmo AI/Linkverse, Lainate, 20045, Milan, Italy.
| |
Collapse
|
18
|
Shaukat A, Tuskey A, Rao VL, Dominitz JA, Murad MH, Keswani RN, Bazerbachi F, Day LW. Interventions to improve adenoma detection rates for colonoscopy. Gastrointest Endosc 2022; 96:171-183. [PMID: 35680469 DOI: 10.1016/j.gie.2022.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Anne Tuskey
- Division of Gastroenterology, Department of Medicine, University of Virginia, Arlington, Virginia, USA
| | - Vijaya L Rao
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Jason A Dominitz
- Division of Gastroenterology, Department of Medicine, Puget Sound Veterans Affairs Medical Center and University of Washington, Seattle, Washington, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Fateh Bazerbachi
- Division of Gastroenterology, CentraCare, Interventional Endoscopy Program, St Cloud, Minnesota, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and University of San Francisco, San Francisco, California, USA
| | | |
Collapse
|
19
|
Auriemma F, Sferrazza S, Bianchetti M, Savarese MF, Lamonaca L, Paduano D, Piazza N, Giuffrida E, Mete LS, Tucci A, Milluzzo SM, Iannelli C, Repici A, Mangiavillano B. From advanced diagnosis to advanced resection in early neoplastic colorectal lesions: Never-ending and trending topics in the 2020s. World J Gastrointest Surg 2022; 14:632-655. [PMID: 36158280 PMCID: PMC9353749 DOI: 10.4240/wjgs.v14.i7.632] [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] [Received: 02/07/2021] [Revised: 05/02/2021] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer screening. In the world there are different approaches to the topic of colorectal cancer prevention and screening: different starting ages (45-50 years); different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests; recto-sigmoidoscopy; and colonoscopy. The key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination, experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination, knowledge in the field of resection of these lesions (from cold-snaring, through endoscopic mucosal resection and endoscopic submucosal dissection, up to advanced tools), and management of complications.
Collapse
Affiliation(s)
- Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento 38014, Italy
| | - Mario Bianchetti
- Digestive Endoscopy Unit, San Giuseppe Hospital - Multimedica, Milan 20123, Italy
| | - Maria Flavia Savarese
- Department of Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo 18038, Italy
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Nicole Piazza
- Gastroenterology Unit, IRCCS Policlinico San Donato, San Donato Milanese; Department of Biomedical Sciences for Health, University of Milan, Milan 20122, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico “G. Giaccone", Palermo 90127, Italy
| | - Lupe Sanchez Mete
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Alessandra Tucci
- Department of Gastroenterology, Molinette Hospital, Città della salute e della Scienza di Torino, Turin 10126, Italy
| | | | - Chiara Iannelli
- Department of Health Sciences, Magna Graecia University, Catanzaro 88100, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit and Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano 20089, Italy
| | - Benedetto Mangiavillano
- Biomedical Science, Hunimed, Pieve Emanuele 20090, Italy
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese 21053, Italy
| |
Collapse
|
20
|
Application of an Artificial Intelligence System Recognition Based on the Deep Neural Network Algorithm. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4623188. [PMID: 35875769 PMCID: PMC9303100 DOI: 10.1155/2022/4623188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022]
Abstract
With the development of artificial intelligence and computer technology, the deep neural network algorithm is applied to the intelligentization of various fields of production and life. However, from the current application status, the application of artificial intelligence technology has many shortcomings. Based on this, this paper starts with the deep neural network algorithm, takes face recognition as the research tool, and deeply studies how to use the deep neural network algorithm to demonstrate the application of intelligent face recognition in complex environments. A face recognition neural network algorithm is proposed, and the accuracy of the algorithm is checked by testing. The results show that the average accuracy of a single sample in the LFW dataset is 99.17%, and the efficiency of using a single sample is close to that of many smelting models, which can be applied to various intelligent recognition scenarios.
Collapse
|
21
|
Aziz M, Ahmed Z, Haghbin H, Pervez A, Goyal H, Kamal F, Kobeissy A, Nawras A, Adler DG. Does i-scan improve adenoma detection rate compared to high-definition colonoscopy? A systematic review and meta-analysis. Endosc Int Open 2022; 10:E824-E831. [PMID: 35692917 PMCID: PMC9187364 DOI: 10.1055/a-1794-0346] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/24/2022] [Indexed: 11/08/2022] Open
Abstract
Background and study aims Recent studies evaluated the impact of i-scan in improving the adenoma detection rate (ADR) compared to high-definition (HD) colonoscopy. We aimed to systematically review and analyze the impact of this technique. Methods A thorough search of the following databases was undertaken: PubMed/Medline, EMBASE, Cochrane and Web of Science. Full-text RCTs and cohort studies directly comparing i-scan and HD colonoscopy were deemed eligible for inclusion. Dichotomous outcomes were pooled and compared using random effects model and DerSimonian-Laird approach. For each outcome, relative risk (RR), 95 % confidence interval (CI), and P value was generated. P < 0.05 was considered statistically significant. Results A total of five studies with six arms were included in this analysis. A total of 2620 patients (mean age 58.6 ± 7.2 years and female proportion 44.8 %) completed the study and were included in our analysis. ADR was significantly higher with any i-scan (RR: 1.20, [CI: 1.06-1.34], P = 0.003) compared to HD colonoscopy. Subgroup analysis demonstrated that ADR was significantly higher using i-scan with surface and contrast enhancement only (RR: 1.25, [CI: 1.07-1.47], P = 0.004). Conclusions i-scan has the potential to increase ADR using the surface and contrast enhancement method. Future studies evaluating other outcomes of interest such as proximal adenomas and serrated lesions are warranted.
Collapse
Affiliation(s)
- Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
| | - Zohaib Ahmed
- Department of Internal Medicine, University of Toledo, Toledo, Ohio, United States
| | - Hossein Haghbin
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan, United States
| | - Asad Pervez
- Division of Gastroenterology and Hepatology, West Virginia University, Morgantown, West Virginia, United States
| | - Hemant Goyal
- Division of Gastroenterology and Hepatology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
| | - Faisal Kamal
- Division of Gastroenterology, University of California, San Francisco, California, United States
| | - Abdallah Kobeissy
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, Colorado, United States
| |
Collapse
|
22
|
Ikematsu H, Murano T, Shinmura K. Detection of colorectal lesions during colonoscopy. DEN OPEN 2022; 2:e68. [PMID: 35310752 PMCID: PMC8828173 DOI: 10.1002/deo2.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022]
Abstract
Owing to its high mortality rate, the prevention of colorectal cancer is of particular importance. The resection of colorectal polyps is reported to drastically reduce colorectal cancer mortality, and examination by endoscopists who had a high adenoma detection rate was found to lower the risk of colorectal cancer, highlighting the importance of identifying lesions. Various devices, imaging techniques, and diagnostic tools aimed at reducing the rate of missed lesions have therefore been developed to improve detection. The distal attachments and devices for improving the endoscopic view angle are intended to help avoid missing blind spots such as folds and flexures in the colon, whereas the imaging techniques represented by image‐enhanced endoscopy contribute to improving lesion visibility. Recent advances in artificial intelligence‐supported detection systems are expected to supplement an endoscopist's eye through the instant diagnosis of the lesions displayed on the monitor. In this review, we provide an outline of each tool and assess its impact on the reduction in the incidence of missed colorectal polyps by summarizing previous clinical research and meta‐analyses. Although useful, the many devices, image‐enhanced endoscopy, and artificial intelligence tools exhibited various limitations. Integrating these tools can improve their shortcomings. Combining artificial intelligence‐based diagnoses with wide‐angle image‐enhanced endoscopy may be particularly useful. Thus, we hope that such tools will be available in the near future.
Collapse
Affiliation(s)
- Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy Exploratory Oncology Research & Clinical Trial Center National Cancer Center Chiba Japan.,Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
| |
Collapse
|
23
|
Effect of artificial intelligence-aided colonoscopy for adenoma and polyp detection: a meta-analysis of randomized clinical trials. Int J Colorectal Dis 2022; 37:495-506. [PMID: 34762157 DOI: 10.1007/s00384-021-04062-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This meta-analysis aimed to determine whether artificial intelligence (AI) improves colonoscopy outcome metrics i.e. adenoma detection rate (ADR) and polyp detection rate (PDR). METHODS Two authors independently searched Web of Science, PubMed, Science Direct, and Cochrane Library to find all published research before July 2021 that has compared AI-aided colonoscopy with routine colonoscopy (RC) for detection of adenoma and polyp. RESULTS This meta-analysis included 10 RCTs with 6629 individuals in AI-aided (n = 3300) and routine (n = 3329) groups. The results showed that both ADR (RR, 1.43; P < 0.001) and PDR (RR, 1.44; P < 0.001) using AI-aided endoscopy were significantly greater when compared with RC. The adenomas detected per colonoscopy (APC) (WMD, 0.25; P = 0.009), polyps detected per colonoscopy (PPC) (WMD, 0.52; P < 0.001), and sessile serrated lesions detected per colonoscopy (SSLPC) (RR, 1.53; P < 0.001) were significantly higher in the AI-aided group compared with the RC group. Subgroup analysis based on size, location, and shape of adenomas and polyps demonstrated that, except for in the cecum and pedunculated adenomas or polyps, the AI-aided groups of the other subgroups are more advantageous. Withdrawal time was longer in the AI-aided group when biopsies were included, while withdrawal time excluding biopsy time showed no significant difference. CONCLUSIONS AI-aided polyp detection system significantly increases lesion detection rate. In addition, lesion detection by AI is hardly affected by factors such as size, location, and shape.
Collapse
|
24
|
Pan H, Cai M, Liao Q, Jiang Y, Liu Y, Zhuang X, Yu Y. Artificial Intelligence-Aid Colonoscopy Vs. Conventional Colonoscopy for Polyp and Adenoma Detection: A Systematic Review of 7 Discordant Meta-Analyses. Front Med (Lausanne) 2022; 8:775604. [PMID: 35096870 PMCID: PMC8792899 DOI: 10.3389/fmed.2021.775604] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives: Multiple meta-analyses which investigated the comparative efficacy and safety of artificial intelligence (AI)-aid colonoscopy (AIC) vs. conventional colonoscopy (CC) in the detection of polyp and adenoma have been published. However, a definitive conclusion has not yet been generated. This systematic review selected from discordant meta-analyses to draw a definitive conclusion about whether AIC is better than CC for the detection of polyp and adenoma. Methods: We comprehensively searched potentially eligible literature in PubMed, Embase, Cochrane library, and China National Knowledgement Infrastructure (CNKI) databases from their inceptions until to April 2021. Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to assess the methodological quality. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used to assess the reporting quality. Two investigators independently used the Jadad decision algorithm to select high-quality meta-analyses which summarized the best available evidence. Results: Seven meta-analyses met our selection criteria finally. AMSTAR score ranged from 8 to 10, and PRISMA score ranged from 23 to 26. According to the Jadad decision algorithm, two high-quality meta-analyses were selected. These two meta-analyses suggested that AIC was superior to CC for colonoscopy outcomes, especially for polyp detection rate (PDR) and adenoma detection rate (ADR). Conclusion: Based on the best available evidence, we conclude that AIC should be preferentially selected for the route screening of colorectal lesions because it has potential value of increasing the polyp and adenoma detection. However, the continued improvement of AIC in differentiating the shape and pathology of colorectal lesions is needed.
Collapse
Affiliation(s)
- Hui Pan
- Department of Endoscopy, Shanghai Jiangong Hospital, Shanghai, China
| | - Mingyan Cai
- Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Liao
- Department of Gastroenterology, Shanghai Jiangong Hospital, Shanghai, China
| | - Yong Jiang
- Department of Surgery, Shanghai Jiangong Hospital, Shanghai, China
| | - Yige Liu
- Department of Endoscopy, Shanghai Jiangong Hospital, Shanghai, China
| | - Xiaolong Zhuang
- Department of Endoscopy, Shanghai Jiangong Hospital, Shanghai, China
| | - Ying Yu
- Department of Endoscopy, Shanghai Jiangong Hospital, Shanghai, China
| |
Collapse
|
25
|
Sánchez-Peralta LF, Pagador JB, Sánchez-Margallo FM. Artificial Intelligence for Colorectal Polyps in Colonoscopy. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
26
|
Research on the Path of Network Opinion Expression in AI Environment for College Students. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:4360792. [PMID: 34925540 PMCID: PMC8674046 DOI: 10.1155/2021/4360792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 11/18/2022]
Abstract
Network interaction has evolved into a grouping paradigm as civilization has progressed and artificial intelligence technology has advanced. This network group model has quickly extended communication space, improved communication content, and tailored to the demands of netizens. The fast growth of the network community on campus can assist students in meeting a variety of communication needs and serve as a vital platform for their studies and daily lives. It is investigated how to extract opinion material from comment text. A strategy for extracting opinion attitude words and network opinion characteristic words from a single comment text is offered at a finer level. The development of a semiautonomous domain emotion dictionary generating technique improves the accuracy of opinion and attitude word extraction. This paper proposes a window-constrained Latent Dirichlet Allocation (LDA) topic model that improves the accuracy of extracting network opinion feature words and ensures that network opinion feature words and opinion attitude words are synchronized by using the location information of opinion attitude words. The two-stage opinion leader mining approach and the linear threshold model based on user roles are the subjects of model simulation tests in this study. It is demonstrated that the two-stage opinion leader mining method suggested in this study can greatly reduce the running time while properly finding opinion leaders with stronger leadership by comparing the results with existing models. It also shows that the linear threshold model based on user roles proposed in this paper can effectively limit the total number of active users who are activated multiple times during the information diffusion process by distinguishing the effects of different user roles on the information diffusion process.
Collapse
|
27
|
Markarian E, Fung BM, Girotra M, Tabibian JH. Large polyps: Pearls for the referring and receiving endoscopist. World J Gastrointest Endosc 2021; 13:638-648. [PMID: 35070025 PMCID: PMC8716985 DOI: 10.4253/wjge.v13.i12.638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/04/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Polyps are precursors to colorectal cancer, the third most common cancer in the United States. Large polyps, i.e.,, those with a size ≥ 20 mm, are more likely to harbor cancer. Colonic polyps can be removed through various techniques, with the goal to completely resect and prevent colorectal cancer; however, the management of large polyps can be relatively complex and challenging. Such polyps are generally more difficult to remove en bloc with conventional methods, and depending on level of expertise, may consequently be resected piecemeal, leading to an increased rate of incomplete removal and thus polyp recurrence. To effectively manage large polyps, endoscopists should be able to: (1) Evaluate the polyp for characteristics which predict high difficulty of resection or incomplete removal; (2) Determine the optimal resection technique (e.g., snare polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection, etc.); and (3) Recognize when to refer to colleagues with greater expertise. This review covers important considerations in this regard for referring and receiving endoscopists and methods to best manage large colonic polyps.
Collapse
Affiliation(s)
- Eric Markarian
- Academy of Science and Medicine, Crescenta Valley High School, Los Angeles, CA 91214, United States
| | - Brian M Fung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ 85006, United States
- Division of Gastroenterology, Banner - University Medical Center Phoenix, Phoenix, AZ 85006, United States
| | - Mohit Girotra
- Section of Gastroenterology and Therapeutic Endoscopy, Digestive Health Institute, Swedish Medical Center, Seattle, WA 98104, United States
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| |
Collapse
|
28
|
Facial Recognition Intensity in Disease Diagnosis Using Automatic Facial Recognition. J Pers Med 2021; 11:jpm11111172. [PMID: 34834524 PMCID: PMC8621146 DOI: 10.3390/jpm11111172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 01/05/2023] Open
Abstract
Artificial intelligence (AI) technology is widely applied in different medical fields, including the diagnosis of various diseases on the basis of facial phenotypes, but there is no evaluation or quantitative synthesis regarding the performance of artificial intelligence. Here, for the first time, we summarized and quantitatively analyzed studies on the diagnosis of heterogeneous diseases on the basis on facial features. In pooled data from 20 systematically identified studies involving 7 single diseases and 12,557 subjects, quantitative random-effects models revealed a pooled sensitivity of 89% (95% CI 82% to 93%) and a pooled specificity of 92% (95% CI 87% to 95%). A new index, the facial recognition intensity (FRI), was established to describe the complexity of the association of diseases with facial phenotypes. Meta-regression revealed the important contribution of FRI to heterogeneous diagnostic accuracy (p = 0.021), and a similar result was found in subgroup analyses (p = 0.003). An appropriate increase in the training size and the use of deep learning models helped to improve the diagnostic accuracy for diseases with low FRI, although no statistically significant association was found between accuracy and photographic resolution, training size, AI architecture, and number of diseases. In addition, a novel hypothesis is proposed for universal rules in AI performance, providing a new idea that could be explored in other AI applications.
Collapse
|
29
|
Clinical impact and quality of randomized controlled trials involving interventions evaluating artificial intelligence prediction tools: a systematic review. NPJ Digit Med 2021; 4:154. [PMID: 34711955 PMCID: PMC8553754 DOI: 10.1038/s41746-021-00524-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/30/2021] [Indexed: 12/23/2022] Open
Abstract
The evidence of the impact of traditional statistical (TS) and artificial intelligence (AI) tool interventions in clinical practice was limited. This study aimed to investigate the clinical impact and quality of randomized controlled trials (RCTs) involving interventions evaluating TS, machine learning (ML), and deep learning (DL) prediction tools. A systematic review on PubMed was conducted to identify RCTs involving TS/ML/DL tool interventions in the past decade. A total of 65 RCTs from 26,082 records were included. A majority of them had model development studies and generally good performance was achieved. The function of TS and ML tools in the RCTs mainly included assistive treatment decisions, assistive diagnosis, and risk stratification, but DL trials were only conducted for assistive diagnosis. Nearly two-fifths of the trial interventions showed no clinical benefit compared to standard care. Though DL and ML interventions achieved higher rates of positive results than TS in the RCTs, in trials with low risk of bias (17/65) the advantage of DL to TS was reduced while the advantage of ML to TS disappeared. The current applications of DL were not yet fully spread performed in medicine. It is predictable that DL will integrate more complex clinical problems than ML and TS tools in the future. Therefore, rigorous studies are required before the clinical application of these tools.
Collapse
|
30
|
El-Nakeep S, El-Nakeep M. Artificial intelligence for cancer detection in upper gastrointestinal endoscopy, current status, and future aspirations. Artif Intell Gastroenterol 2021; 2:124-132. [DOI: 10.35712/aig.v2.i5.124] [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] [Received: 06/06/2021] [Revised: 06/26/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
This minireview discusses the benefits and pitfalls of machine learning, and artificial intelligence in upper gastrointestinal endoscopy for the detection and characterization of neoplasms. We have reviewed the literature for relevant publications on the topic using PubMed, IEEE, Science Direct, and Google Scholar databases. We discussed the phases of machine learning and the importance of advanced imaging techniques in upper gastrointestinal endoscopy and its association with artificial intelligence.
Collapse
Affiliation(s)
- Sarah El-Nakeep
- Gastroenterology and Hepatology Unit, Internal Medicine Department, Faculty of Medicine, AinShams University, Cairo 11591, Egypt
| | - Mohamed El-Nakeep
- Master of Science in Electrical Engineering "Electronics and Communications", Electronics and Electrical Engineering Department, Faculty of Engineering, Ain Shams University, Cairo 11736, Egypt
- Bachelor of Science in Electronics and Electrical Communications, Electronics and Communications and Computers Department, Faculty of Engineering, Helwan University, Cairo 11736, Egypt
| |
Collapse
|
31
|
Ang TL, East JE. Image-enhanced endoscopy for detection and diagnosis of colonic neoplasia: Time to shift focus. J Gastroenterol Hepatol 2021; 36:2635-2636. [PMID: 34622988 DOI: 10.1111/jgh.15684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital; Duke-NUS Medical School; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.,Mayo Clinic Healthcare London, London, UK
| |
Collapse
|
32
|
Pecere S, Milluzzo SM, Esposito G, Dilaghi E, Telese A, Eusebi LH. Applications of Artificial Intelligence for the Diagnosis of Gastrointestinal Diseases. Diagnostics (Basel) 2021; 11:diagnostics11091575. [PMID: 34573917 PMCID: PMC8469485 DOI: 10.3390/diagnostics11091575] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022] Open
Abstract
The development of convolutional neural networks has achieved impressive advances of machine learning in recent years, leading to an increasing use of artificial intelligence (AI) in the field of gastrointestinal (GI) diseases. AI networks have been trained to differentiate benign from malignant lesions, analyze endoscopic and radiological GI images, and assess histological diagnoses, obtaining excellent results and high overall diagnostic accuracy. Nevertheless, there data are lacking on side effects of AI in the gastroenterology field, and high-quality studies comparing the performance of AI networks to health care professionals are still limited. Thus, large, controlled trials in real-time clinical settings are warranted to assess the role of AI in daily clinical practice. This narrative review gives an overview of some of the most relevant potential applications of AI for gastrointestinal diseases, highlighting advantages and main limitations and providing considerations for future development.
Collapse
Affiliation(s)
- Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00135 Rome, Italy;
- Center for Endoscopic Research Therapeutics and Training (CERTT), Catholic University, 00168 Rome, Italy
- Correspondence: (S.P.); (L.H.E.)
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00135 Rome, Italy;
- Fondazione Poliambulanza Istituto Ospedaliero, 25121 Brescia, Italy
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00168 Rome, Italy; (G.E.); (E.D.)
| | - Emanuele Dilaghi
- Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00168 Rome, Italy; (G.E.); (E.D.)
| | - Andrea Telese
- Department of Gastroenterology, University College London Hospital (UCLH), London NW1 2AF, UK;
| | - Leonardo Henry Eusebi
- Division of Gastroenterology and Endoscopy, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40121 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40121 Bologna, Italy
- Correspondence: (S.P.); (L.H.E.)
| |
Collapse
|
33
|
Bang CS, Lee JJ, Baik GH. Computer-Aided Diagnosis of Diminutive Colorectal Polyps in Endoscopic Images: Systematic Review and Meta-analysis of Diagnostic Test Accuracy. J Med Internet Res 2021; 23:e29682. [PMID: 34432643 PMCID: PMC8427459 DOI: 10.2196/29682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/04/2021] [Accepted: 07/27/2021] [Indexed: 12/19/2022] Open
Abstract
Background Most colorectal polyps are diminutive and benign, especially those in the rectosigmoid colon, and the resection of these polyps is not cost-effective. Advancements in image-enhanced endoscopy have improved the optical prediction of colorectal polyp histology. However, subjective interpretability and inter- and intraobserver variability prohibits widespread implementation. The number of studies on computer-aided diagnosis (CAD) is increasing; however, their small sample sizes limit statistical significance. Objective This review aims to evaluate the diagnostic test accuracy of CAD models in predicting the histology of diminutive colorectal polyps by using endoscopic images. Methods Core databases were searched for studies that were based on endoscopic imaging, used CAD models for the histologic diagnosis of diminutive colorectal polyps, and presented data on diagnostic performance. A systematic review and diagnostic test accuracy meta-analysis were performed. Results Overall, 13 studies were included. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of diminutive colorectal polyps (adenomatous or neoplastic vs nonadenomatous or nonneoplastic) were 0.96 (95% CI 0.93-0.97), 0.93 (95% CI 0.91-0.95), 0.87 (95% CI 0.76-0.93), and 87 (95% CI 38-201), respectively. The meta-regression analysis showed no heterogeneity, and no publication bias was detected. Subgroup analyses showed robust results. The negative predictive value of CAD models for the diagnosis of adenomatous polyps in the rectosigmoid colon was 0.96 (95% CI 0.95-0.97), and this value exceeded the threshold of the diagnosis and leave strategy. Conclusions CAD models show potential for the optical histological diagnosis of diminutive colorectal polyps via the use of endoscopic images. Trial Registration PROSPERO CRD42021232189; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232189
Collapse
Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Institute for Liver and Digestive Diseases, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Institute for Liver and Digestive Diseases, Hallym University College of Medicine, Chuncheon, Republic of Korea
| |
Collapse
|
34
|
Artificial intelligence can increase the detection rate of colorectal polyps and adenomas: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2021; 33:1041-1048. [PMID: 32804846 DOI: 10.1097/meg.0000000000001906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Colonoscopy is an important method to diagnose polyps, especially adenomatous polyps. However, the rate of missed diagnoses is relatively high. In this study, we aimed to determine whether artificial intelligence (AI) improves the polyp detection rate (PDR) and adenoma detection rate (ADR) with colonoscopy. We performed a systematic search in PubMed, Cochrane Library, Embase, and Web of Science databases; the search included entries in the databases up to and including 29 February 2020. Five articles that involved a total of 4311 patients fulfilled the selection criteria. The results of these studies showed that both PDR and ADR increased with the assistance of AI compared with those in control groups {pooled odds ratio (OR) = 1.91 [95% confidence interval (CI) 1.68-2.16] and 1.75 (95% CI 1.52-2.01), respectively}. Good bowel preparation reduced the impact of AI, but significant differences were still apparent in PDR and ADR [pooled OR = 1.69 (95% CI 1.32-2.16) and 1.36 (95% CI 1.04-1.78), respectively]. The characteristics of polyps and adenomas also influenced the results. The average number of polyps and adenomas detected varied significantly by location, and small polyps and adenomas were more likely to be missed. However, the effect of the morphology of polyps and AI-assisted detection needs further studies. In conclusion, AI increases the detection rates of polyps and adenomas in colonoscopy. Without AI assistance, detection rates can be improved with better bowel preparation and training for small polyp and adenoma detection.
Collapse
|
35
|
Aziz M, Mehta TI, Weissman S, Sharma S, Fatima R, Khan Z, Dasari CS, Lee-Smith W, Nawras A, Adler DG. Do Water-aided Techniques Improve Serrated Polyp Detection Rate During Colonoscopy?: A Systematic Review With Meta-Analysis. J Clin Gastroenterol 2021; 55:520-527. [PMID: 33355836 DOI: 10.1097/mcg.0000000000001386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/26/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS The utility of water-aided techniques (WT): water exchange (WE) and water immersion (WI) have been studied extensively in the literature for improving colonoscopy outcome metrics such as adenoma detection rate. Serrated polyps owing to their location and appearance have a high miss rate. The authors performed a systematic review and meta-analysis of studies comparing WT with the standard gas-assisted (GA) method to determine if there was any impact on serrated polyp detection rate (SPDR) and sessile serrated polyp detection rate. METHODS The following databases were queried for this systematic review: Medline, EMBASE, Cochrane Library, CINAHL, and Web of Sciences. The authors only included randomized controlled trials (RCTs). The primary outcome was SPDR and secondary outcomes were sessile serrated polyp detection rate and cecal intubation rate. Risk ratios (RRs) were calculated for each outcome. A P-value <0.05 was considered to be statistically significant. RESULTS A total of 4 RCTs (5 arms) with 5306 patients (2571 in the GA group and 2735 in the WT group) were included. The SPDR was significantly increased for the WT group compared with GA (6.1% vs. 3.8%; RR, 1.63; 95% confidence interval, 1.24-2.13; P<0.001; I2=22.7%). A subgroup analysis for WE technique also demonstrated improved SPDR compared with the GA method (4.9% vs. 3.2%; RR, 1.57; 95% confidence interval, 1.15-2.14; P=0.004; I2=6.1%). CONCLUSIONS WT, particularly, the WE method results in improved SPDR. This technique should be encouraged in a clinical setting to detect these polyps to prevent interval colorectal cancer.
Collapse
Affiliation(s)
| | - Tej I Mehta
- Department of Medicine, University of South Dakota Sanford, School of Medicine, Vermillion, SD
| | - Simcha Weissman
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, NJ
| | | | | | - Zubair Khan
- Department of Gastroenterology, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | - Chandra S Dasari
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
| | | | - Ali Nawras
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, UT
| |
Collapse
|
36
|
Cao B, Zhang KC, Wei B, Chen L. Status quo and future prospects of artificial neural network from the perspective of gastroenterologists. World J Gastroenterol 2021; 27:2681-2709. [PMID: 34135549 PMCID: PMC8173384 DOI: 10.3748/wjg.v27.i21.2681] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/29/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial neural networks (ANNs) are one of the primary types of artificial intelligence and have been rapidly developed and used in many fields. In recent years, there has been a sharp increase in research concerning ANNs in gastrointestinal (GI) diseases. This state-of-the-art technique exhibits excellent performance in diagnosis, prognostic prediction, and treatment. Competitions between ANNs and GI experts suggest that efficiency and accuracy might be compatible in virtue of technique advancements. However, the shortcomings of ANNs are not negligible and may induce alterations in many aspects of medical practice. In this review, we introduce basic knowledge about ANNs and summarize the current achievements of ANNs in GI diseases from the perspective of gastroenterologists. Existing limitations and future directions are also proposed to optimize ANN’s clinical potential. In consideration of barriers to interdisciplinary knowledge, sophisticated concepts are discussed using plain words and metaphors to make this review more easily understood by medical practitioners and the general public.
Collapse
Affiliation(s)
- Bo Cao
- Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Ke-Cheng Zhang
- Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Bo Wei
- Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| |
Collapse
|
37
|
Zhang M, Zhu C, Wang Y, Kong Z, Hua Y, Zhang W, Si X, Ye B, Xu X, Li L, Heng D, Liu B, Tian S, Wu J, Dang Y, Zhang G. Differential diagnosis for esophageal protruded lesions using a deep convolution neural network in endoscopic images. Gastrointest Endosc 2021; 93:1261-1272.e2. [PMID: 33065026 DOI: 10.1016/j.gie.2020.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Recent advances in deep convolutional neural networks (CNNs) have led to remarkable results in digestive endoscopy. In this study, we aimed to develop CNN-based models for the differential diagnosis of benign esophageal protruded lesions using endoscopic images acquired during real clinical settings. METHODS We retrospectively reviewed the images from 1217 patients who underwent white-light endoscopy (WLE) and EUS between January 2015 and April 2020. Three deep CNN models were developed to accomplish the following tasks: (1) identification of esophageal benign lesions from healthy controls using WLE images; (2) differentiation of 3 subtypes of esophageal protruded lesions (including esophageal leiomyoma [EL], esophageal cyst (EC], and esophageal papilloma [EP]) using WLE images; and (3) discrimination between EL and EC using EUS images. Six endoscopists blinded to the patients' clinical status were enrolled to interpret all images independently. Their diagnostic performances were evaluated and compared with the CNN models using the area under the receiver operating characteristic curve (AUC). RESULTS For task 1, the CNN model achieved an AUC of 0.751 (95% confidence interval [CI], 0.652-0.850) in identifying benign esophageal lesions. For task 2, the proposed model using WLE images for differentiation of esophageal protruded lesions achieved an AUC of 0.907 (95% CI, 0.835-0.979), 0.897 (95% CI, 0.841-0.953), and 0.868 (95% CI, 0.769-0.968) for EP, EL, and EC, respectively. The CNN model achieved equivalent or higher identification accuracy for EL and EC compared with skilled endoscopists. In the task of discriminating EL from EC (task 3), the proposed CNN model had AUC values of 0.739 (EL, 95% CI, 0.600-0.878) and 0.724 (EC, 95% CI, 0.567-0.881), which outperformed seniors and novices. Attempts to combine the CNN and endoscopist predictions led to significantly improved diagnostic accuracy compared with endoscopists interpretations alone. CONCLUSIONS Our team established CNN-based methodologies to recognize benign esophageal protruded lesions using routinely obtained WLE and EUS images. Preliminary results combining the results from the models and the endoscopists underscored the potential of ensemble models for improved differentiation of lesions in real endoscopic settings.
Collapse
Affiliation(s)
- Min Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zihao Kong
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yifei Hua
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weifeng Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinmin Si
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bixing Ye
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaobing Xu
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lurong Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ding Heng
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | | | | - Yini Dang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guoxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
38
|
Kim KO, Kim EY. Application of Artificial Intelligence in the Detection and Characterization of Colorectal Neoplasm. Gut Liver 2021; 15:346-353. [PMID: 32773386 PMCID: PMC8129657 DOI: 10.5009/gnl20186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 12/19/2022] Open
Abstract
Endoscpists always have tried to pursue a perfect colonoscopy, and application of artificial intelligence (AI) using deep-learning algorithms is one of the promising supportive options for detection and characterization of colorectal polyps during colonoscopy. Many retrospective studies conducted with real-time application of AI using convolutional neural networks have shown improved colorectal polyp detection. Moreover, a recent randomized clinical trial reported additional polyp detection with shorter analysis time. Studies conducted regarding polyp characterization provided additional promising results. Application of AI with narrow band imaging in real-time prediction of the pathology of diminutive polyps resulted in high diagnostic accuracy. In addition, application of AI with endocytoscopy or confocal laser endomicroscopy was investigated for real-time cellular diagnosis, and the diagnostic accuracy of some studies was comparable to that of pathologists. With AI technology, we can expect a higher polyp detection rate with reduced time and cost by avoiding unnecessary procedures, resulting in enhanced colonoscopy efficiency. However, for AI application in actual daily clinical practice, more prospective studies with minimized selection bias, consensus on standardized utilization, and regulatory approval are needed. (Gut Liver 2021;15:-353)
Collapse
Affiliation(s)
- Kyeong Ok Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Young Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| |
Collapse
|
39
|
Sánchez-Peralta LF, Pagador JB, Sánchez-Margallo FM. Artificial Intelligence for Colorectal Polyps in Colonoscopy. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_308-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
40
|
Aziz M, Haghbin H, Gangwani MK, Sharma S, Nawras Y, Khan Z, Chandan S, Mohan BP, Lee-Smith W, Nawras A. Efficacy of Endocuff Vision compared to first-generation Endocuff in adenoma detection rate and polyp detection rate in high-definition colonoscopy: a systematic review and network meta-analysis. Endosc Int Open 2021; 9:E41-E50. [PMID: 33403235 PMCID: PMC7775814 DOI: 10.1055/a-1293-7327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
Background and study aims Recently, the newer Endocuff Vision (ECV) has been evaluated for improving colonoscopy outcome metrics such as adenoma detection rate (ADR) and polyp detection rate (PDR). Due to lack of direct comparative studies between ECV and original Endocuff (ECU), we performed a systematic review and network meta-analysis to evaluate these outcomes. Methods The following databases were searched: PubMed, Embase, Cochrane, and Web of Sciences to include randomized controlled trials (RCTs) comparing ECV or ECU colonoscopy to high-definition (HD) colonoscopy. Direct as well as network meta-analyses comparing ADR and PDR were performed using a random effects model. Relative-risk (RR) with 95 % confidence interval (CI) was calculated. Results A total of 12 RCTs with 8638 patients were included in the final analysis. On direct meta-analysis, ECV did not demonstrate statistically improved ADR compared to HD colonoscopy (RR: 1.12, 95 % CI 0.99-1.27). A clinically and statistically improved PDR was noted for ECV compared to HD (RR: 1.15, 95 % CI 1.03-1.28) and ECU compared to HD (RR: 1.26, 95 % CI 1.09-1.46) as well as improved ADR (RR: 1.22, 95 % CI 1.05-1.43) was observed for ECU colonoscopy when compared to HD colonoscopy. These results were also consistent on network meta-analysis. Lower overall complication rates (RR: 0.14, 95 % CI 0.02-0.84) and particularly lacerations/erosions (RR: 0.11, 95 % CI 0.02-0.70) were noted with ECV compared to ECU colonoscopy. Conclusions Although safe, the newer ECV did not significantly improve ADR compared to ECU and HD colonoscopy. Further device modification is needed to increase the overall ADR and PDR.
Collapse
Affiliation(s)
- Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Hossein Haghbin
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, Mercy Hospital St. Louis, St. louis, Missouri, 63141
| | - Sachit Sharma
- Department of Internal Medicine, University of Toledo and Promedica Toledo Hospital, Toledo, Ohio, United States
| | - Yusuf Nawras
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Zubair Khan
- Department of Gastroenterology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Babu P. Mohan
- Divison of Gastroenterology and Hepatology, University of Utah Healthcare, Salt Lake City, Utah, United States
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
| |
Collapse
|
41
|
Parasher G, Wong M, Rawat M. Evolving role of artificial intelligence in gastrointestinal endoscopy. World J Gastroenterol 2020; 26:7287-7298. [PMID: 33362384 PMCID: PMC7739161 DOI: 10.3748/wjg.v26.i46.7287] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/02/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is a combination of different technologies that enable machines to sense, comprehend, and learn with human-like levels of intelligence. AI technology will eventually enhance human capability, provide machines genuine autonomy, and reduce errors, and increase productivity and efficiency. AI seems promising, and the field is full of invention, novel applications; however, the limitation of machine learning suggests a cautious optimism as the right strategy. AI is also becoming incorporated into medicine to improve patient care by speeding up processes and achieving greater accuracy for optimal patient care. AI using deep learning technology has been used to identify, differentiate catalog images in several medical fields including gastrointestinal endoscopy. The gastrointestinal endoscopy field involves endoscopic diagnoses and prognostication of various digestive diseases using image analysis with the help of various gastrointestinal endoscopic device systems. AI-based endoscopic systems can reliably detect and provide crucial information on gastrointestinal pathology based on their training and validation. These systems can make gastroenterology practice easier, faster, more reliable, and reduce inter-observer variability in the coming years. However, the thought that these systems will replace human decision making replace gastrointestinal endoscopists does not seem plausible in the near future. In this review, we discuss AI and associated various technological terminologies, evolving role in gastrointestinal endoscopy, and future possibilities.
Collapse
Affiliation(s)
- Gulshan Parasher
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Morgan Wong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Manmeet Rawat
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| |
Collapse
|
42
|
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
|
43
|
PICCOLO White-Light and Narrow-Band Imaging Colonoscopic Dataset: A Performance Comparative of Models and Datasets. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10238501] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Colorectal cancer is one of the world leading death causes. Fortunately, an early diagnosis allows for effective treatment, increasing the survival rate. Deep learning techniques have shown their utility for increasing the adenoma detection rate at colonoscopy, but a dataset is usually required so the model can automatically learn features that characterize the polyps. In this work, we present the PICCOLO dataset, that comprises 3433 manually annotated images (2131 white-light images 1302 narrow-band images), originated from 76 lesions from 40 patients, which are distributed into training (2203), validation (897) and test (333) sets assuring patient independence between sets. Furthermore, clinical metadata are also provided for each lesion. Four different models, obtained by combining two backbones and two encoder–decoder architectures, are trained with the PICCOLO dataset and other two publicly available datasets for comparison. Results are provided for the test set of each dataset. Models trained with the PICCOLO dataset have a better generalization capacity, as they perform more uniformly along test sets of all datasets, rather than obtaining the best results for its own test set. This dataset is available at the website of the Basque Biobank, so it is expected that it will contribute to the further development of deep learning methods for polyp detection, localisation and classification, which would eventually result in a better and earlier diagnosis of colorectal cancer, hence improving patient outcomes.
Collapse
|
44
|
Refai H, Koudsi B, Kudsi OY. Novel polyp detection technology for colonoscopy: 3D optical scanner. Endosc Int Open 2020; 8:E1553-E1559. [PMID: 33140010 PMCID: PMC7577784 DOI: 10.1055/a-1261-3349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background and study aims Fifty-eight percent of American adults aged 50 to 75 undergo colonoscopies. Multiple factors result in missed lesions, at a rate of approximately 20 %, potentially subjecting patients to colorectal cancer. We report on use of a miniaturized optical scanner and accompanying processing software capable of detecting, measuring, and locating polyps with sub-millimeter accuracy, all in real time. Materials and methods A prototype 3 D optical scanner was developed that fits within the dimensions of a standard endoscope. After calibration, the system was evaluated in an ex-vivo porcine colon model, using silicon-made polyps. Results The average distance between two adjacent points in the 3 D point cloud was 94 µm. The results demonstrate high-accuracy measurements and 3 D models while operating at short distances. The scanner detected 6 mm × 3 mm polyps in every trial and identified polyp location with 95-µm accuracy. Registration errors were less than 0.8 % between point clouds based on physical features. Conclusion We demonstrated that a novel 3 D optical scanning system improves the performance of colonoscopy procedures by using a combination of 3 D and 2 D optical scanning and fast, accurate software for extracting data and generating models. Further studies of the system are warranted.
Collapse
Affiliation(s)
- Hakki Refai
- Optecks, LLC, Tulsa, Oklahoma, United States
| | | | - Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, United States
| |
Collapse
|
45
|
Tang CP, Shao PP, Hsieh YH, Leung FW. A review of water exchange and artificial intelligence in improving adenoma detection. Tzu Chi Med J 2020; 33:108-114. [PMID: 33912406 PMCID: PMC8059458 DOI: 10.4103/tcmj.tcmj_88_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/22/2020] [Accepted: 06/06/2020] [Indexed: 12/21/2022] Open
Abstract
Water exchange (WE) and artificial intelligence (AI) have made critical advances during the past decade. WE significantly increases adenoma detection and AI holds the potential to help endoscopists detect more polyps and adenomas. We performed an electronic literature search on PubMed using the following keywords: water-assisted and water exchange colonoscopy, adenoma and polyp detection, artificial intelligence, deep learning, neural networks, and computer-aided colonoscopy. We reviewed relevant articles published in English from 2010 to May 2020. Additional articles were searched manually from the reference lists of the publications reviewed. We discussed recent advances in both WE and AI, including their advantages and limitations. AI may mitigate operator-dependent factors that limit the potential of WE. By increasing bowel cleanliness and improving visualization, WE may provide the platform to optimize the performance of AI for colonoscopies. The strengths of WE and AI may complement each other in spite of their weaknesses to maximize adenoma 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, Taiwan
| | - Paul P Shao
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA.,Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
| | - 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, Taiwan
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA.,Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
46
|
East JE, Rittscher J. Artificial intelligence for colonoscopic polyp detection: High performance versus human nature. J Gastroenterol Hepatol 2020; 35:1663-1664. [PMID: 33043510 DOI: 10.1111/jgh.15262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jens Rittscher
- Institute of Biomedical Engineering, Big Data Institute, University of Oxford, Oxford, UK
| |
Collapse
|
47
|
Comparing endoscopic interventions to improve serrated adenoma detection rates during colonoscopy: a systematic review and network meta-analysis of randomized controlled trials. Eur J Gastroenterol Hepatol 2020; 32:1284-1292. [PMID: 32773510 DOI: 10.1097/meg.0000000000001844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Serrated lesions (sessile serrated adenomas/polyps and traditional serrated adenomas) owing to their subtle appearance and proximal location have a high miss rate. The objective of this study is to compare all the available endoscopic interventions for improving serrated adenoma detection rate (SADR) through a network meta-analysis. METHODS We conducted a systematic review of the available literature (PubMed, Embase, Cochrane and WoS) from inception to 29 November 2019 to identify all the relevant randomized controlled trials. A total of 28 trials with 22 830 patients were included. The studies compared the efficacy of add-on devices (endocap, endocuff, endocuff vision, G-EYE, endorings, AmplifEYE), electronic chromoendoscopy (linked-color imaging, blue laser imaging, narrow band imaging), dye-based chromoendoscopy, full-spectrum endoscopy (FUSE) and water-based techniques (WBT) with each other or high-definition colonoscopy. Both pairwise and network meta-analysis was conducted using the random-effects model. Risk ratios (RR) with 95% confidence intervals (CI) and P-values were calculated. RESULTS Direct meta-analysis demonstrated superiority for WBT (RR: 1.41, CI: 1.01-1.98), add-on devices (RR: 1.53, CI: 1.13-2.08), narrow band imaging (RR: 1.93, CI: 1.12-3.32) and endocuff vision (RR: 1.87, CI: 1.13-3.11) compared to high-definition colonoscopy. The results were consistent on network meta-analysis with chromoendoscopy as an additional modality for improving SADR (RR: 1.74, CI: 1.03-2.93). CONCLUSION In a network meta-analysis, add-on devices (particularly endocuff vision), narrow band imaging, WBT and chromoendoscopy were comparable to each other and improved SADR compared to high-definition colonoscopy.
Collapse
|