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Schöler J, Alavanja M, de Lange T, Yamamoto S, Hedenström P, Varkey J. Impact of AI-aided colonoscopy in clinical practice: a prospective randomised controlled trial. BMJ Open Gastroenterol 2024; 11:e001247. [PMID: 38290758 PMCID: PMC10870789 DOI: 10.1136/bmjgast-2023-001247] [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: 09/04/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE Colorectal cancer (CRC) has a significant role in cancer-related mortality. Colonoscopy, combined with adenoma removal, has proven effective in reducing CRC incidence. However, suboptimal colonoscopy quality often leads to missed polyps. The impact of artificial intelligence (AI) on adenoma and polyp detection rate (ADR, PDR) is yet to be established. DESIGN We conducted a randomised controlled trial at Sahlgrenska University Hospital in Sweden. Patients underwent colonoscopy with or without the assistance of AI (AI-C or conventional colonoscopy (CC)). Examinations were performed with two different AI systems, that is, Fujifilm CADEye and Medtronic GI Genius. The primary outcome was ADR. RESULTS Among 286 patients, 240 underwent analysis (average age: 66 years). The ADR was 42% for all patients, and no significant difference emerged between AI-C and CC groups (41% vs 43%). The overall PDR was 61%, with a trend towards higher PDR in the AI-C group. Subgroup analysis revealed higher detection rates for sessile serrated lesions (SSL) with AI assistance (AI-C 22%, CC 11%, p=0.004). No difference was noticed in the detection of polyps or adenomas per colonoscopy. Examinations were most often performed by experienced endoscopists, 78% (n=86 AI-C, 100 CC). CONCLUSION Amidst the ongoing AI integration, ADR did not improve with AI. Particularly noteworthy is the enhanced detection rates for SSL by AI assistance, especially since they pose a risk for postcolonoscopy CRC. The integration of AI into standard colonoscopy practice warrants further investigation and the development of improved software might be necessary before enforcing its mandatory implementation. TRIAL REGISTRATION NUMBER NCT05178095.
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Affiliation(s)
- Johanna Schöler
- Medical Department, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Marko Alavanja
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Thomas de Lange
- Medical Department, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
| | - Shunsuke Yamamoto
- Department of Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Per Hedenström
- Medical Department, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Jonas Varkey
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
- Division of Gastroenterology, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Keshtkar K, Reza Safarpour A, Heshmat R, Sotoudehmanesh R, Keshtkar A. A Systematic Review and Meta-analysis of Convolutional Neural Network in the Diagnosis of Colorectal Polyps and Cancer. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:985-997. [PMID: 37681266 PMCID: PMC10645297 DOI: 10.5152/tjg.2023.22491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/22/2023] [Indexed: 09/09/2023]
Abstract
Convolutional neural networks are a class of deep neural networks used for different clinical purposes, including improving the detection rate of colorectal lesions. This systematic review and meta-analysis aimed to assess the performance of convolutional neural network-based models in the detection or classification of colorectal polyps and colorectal cancer. A systematic search was performed in MEDLINE, SCOPUS, Web of Science, and other related databases. The performance measures of the convolutional neural network models in the detection of colorectal polyps and colorectal cancer were calculated in the 2 scenarios of the best and worst accuracy. Stata and R software were used for conducting the meta-analysis. From 3368 searched records, 24 primary studies were included. The sensitivity and specificity of convolutional neural network models in predicting colorectal polyps in worst and best scenarios ranged from 84.7% to 91.6% and from 86.0% to 93.8%, respectively. These values in predicting colorectal cancer varied between 93.2% and 94.1% and between 94.6% and 97.7%. The positive and negative likelihood ratios varied between 6.2 and 14.5 and 0.09 and 0.17 in these scenarios, respectively, in predicting colorectal polyps, and 17.1-41.2 and 0.07-0.06 in predicting colorectal polyps. The diagnostic odds ratio and accuracy measures of convolutional neural network models in predicting colorectal polyps in worst and best scenarios ranged between 36% and 162% and between 80.5% and 88.6%, respectively. These values in predicting colorectal cancer in the worst and the best scenarios varied between 239.63% and 677.47% and between 88.2% and 96.4%. The area under the receiver operating characteristic varied between 0.92 and 0.97 in the worst and the best scenarios in colorectal polyps, respectively, and between 0.98 and 0.99 in colorectal polyps prediction. Convolutional neural network-based models showed an acceptable accuracy in detecting colorectal polyps and colorectal cancer.
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Affiliation(s)
- Kamyab Keshtkar
- University of Tehran School of Electrical and Computer Engineering, Tehran, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasoul Sotoudehmanesh
- Department of Gastroenterology, Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Keshtkar
- Department of Health Sciences Education Development, Tehran University of Medical Sciences School of Public Health, Tehran, Iran
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Carter K. A practical approach to selecting a colorectal cancer screening test. JAAPA 2021; 34:18-23. [PMID: 34608013 DOI: 10.1097/01.jaa.0000794976.41120.ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
ABSTRACT Colorectal cancer is the second leading cause of cancer-related deaths in the United States, but timely, effective, and adherent screening can reduce the number of cases. Screening tests continue to evolve, creating opportunities and challenges. Medical societies offer varying guidelines about optimal screening tests and when to begin screening. This article reviews available and emerging colorectal cancer screening tests and discusses how to educate patients, advise them in selecting an appropriate test, and promote increased participation in colorectal cancer screening.
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Affiliation(s)
- Kimberly Carter
- Kimberly Carter is an associate professor in the PA program at Midwestern University in Glendale, Ariz. The author has disclosed no potential conflicts of interest, financial or otherwise
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Maida M, Morreale G, Sinagra E, Ianiro G, Margherita V, Cirrone Cipolla A, Camilleri S. Quality measures improving endoscopic screening of colorectal cancer: a review of the literature. Expert Rev Anticancer Ther 2019; 19:223-235. [PMID: 30614284 DOI: 10.1080/14737140.2019.1565999] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is a major health-care problem all over the world and CRC screening is effective in reducing mortality and increasing the 5-year survival. Colonoscopy has a central role in CRC screening. It can be performed as a primary test, as a recall policy after a positive result of another screening test, and for surveillance. Since effectiveness of endoscopic screening depends on adequate detection and removal of colonic polyps, consistent quality measures, which are useful in enhancing the diagnostic yield of examination, are essential. Areas covered: The aim of this review is to analyze current evidence from literature supporting quality measures able to refine endoscopic screening of colorectal cancer. Expert commentary: Quality measures namely a) time slot allotted to colonoscopy, b) assessment of indication, c) bowel preparation, d) Cecal intubation, e) withdrawal time, f) adenoma detection rate, g) proper management of lesions (polypectomy technique, polyps retrieval rate and tattooing of resection sites), and h) adequate follow-up intervals play a key role in identifying malignant and at-risk lesions and improving the outcome of screening. Adherence to these quality measures is critical to maximize the effectiveness of CRC screening, as well as, a proper technique of colonoscopy and a quality report of the procedure. Among all recommended measures, adenoma detection rate is the most important and must be kept above the recommended quality threshold by all physicians practicing in the setting of screening.
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Affiliation(s)
- Marcello Maida
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Gaetano Morreale
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Emanuele Sinagra
- b Gastroenterology and Endoscopy Unit , Fondazione Istituto San Raffaele Giglio , Cefalù , Italy
| | - Gianluca Ianiro
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Vito Margherita
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Alfonso Cirrone Cipolla
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Salvatore Camilleri
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
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Kump P, Hassan C, Spada C, Brownstone E, Datz C, Haefner M, Renner F, Schoefl R, Schreiber F. Efficacy and safety of a new low-volume PEG with citrate and simethicone bowel preparation for colonoscopy (Clensia): a multicenter randomized observer-blind clinical trial vs. a low-volume PEG with ascorbic acid (PEG-ASC). Endosc Int Open 2018; 6:E907-E913. [PMID: 30083580 PMCID: PMC6070370 DOI: 10.1055/a-0624-2266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/05/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Quality of inspection during colonoscopy is strictly related to the level of cleansing. High-volume (PEG-based) solutions are highly effective and safe, but their high volume affects tolerability and compliance. The aim of this study was to compare a new low-volume PEG with citrate and simethicone solution (PMF 104,Clensia) with a low-volume PEG with ascorbic acid solution (PEG-ASC; Moviprep). PATIENTS AND METHODS This was a multicenter, randomized, observer-blind, parallel-group, phase 3 clinical trial, where patients were randomized between PMF 104 and PEG-ASC. In both groups, patients were instructed to take a full-dose regimen the evening before if colonoscopy was scheduled before 11 am to 12 pm, or to take a split regimen if colonoscopy was scheduled after 11 am to 12 pm. The primary end-point was an equivalence between PMF104 and PEG-ASC in the rate of adequate level of cleansing (Ottawa scale ≤ 6), with safety, mucosal visibility, tolerability, acceptance and compliance being also assessed. RESULTS Of the 403 enrolled, 367 patients (Mean age [SD]: 55.6 (14.4) years; male:166 [45.2 %]) were included in the per protocol (PP) analysis: 184 being randomized in the PMF 104 group and 183 in the PEG-ASC group. Successful bowel cleansing was 78.3 % and 74.3 % in PMF104 and in PEG-ASC, respectively ( P = 0.37). Both preparations were equally safe (mild adverse events were observed in 9.2 % and 9.3 % of patients in the PMF104 and in the PEG-ASC group, respectively) and acceptable (no or mild distress during the intake in 81.4 % and 80.8 % in the PMF104 in the PEG-ASC, respectively [ P = 0.74]). CONCLUSION The new low-volume product Clensia is equivalent to the reference low-volume PEG-ASC in terms of bowel cleansing, safety and acceptance.
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Affiliation(s)
- Patrizia Kump
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria
| | - Cesare Hassan
- Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
- Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Eva Brownstone
- Internal Medicine IV, KH Rudolfstiftung, Vienna, Austria
| | - Christian Datz
- Department of Internal Medicine, Oberndorf Hospital, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Michael Haefner
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Friedrich Renner
- Interne Abteilung, Krankenhaus der Barmherzigen Schwestern Ried, Ried, Austria
| | - Rainer Schoefl
- Internal Medicine IV, KH der Elisabethinen, Linz, Austria.
| | - Florian Schreiber
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria
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