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Helderman NC, van Leerdam ME, Kloor M, Ahadova A, Nielsen M. Emerge of colorectal cancer in Lynch syndrome despite colonoscopy surveillance: A challenge of hide and seek. Crit Rev Oncol Hematol 2024; 197:104331. [PMID: 38521284 DOI: 10.1016/j.critrevonc.2024.104331] [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: 01/13/2024] [Revised: 03/09/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024] Open
Abstract
Even with colonoscopy surveillance, Lynch syndromes (LS) carriers still develop colorectal cancer (CRC). The cumulative incidence of CRCs under colonoscopy surveillance varies depending on the affected mismatch repair (MMR) gene. However, the precise mechanisms driving these epidemiological patterns remain incompletely understood. In recent years, several potential mechanisms explaining the occurrence of CRCs during colonoscopy surveillance have been proposed in individuals with and without LS. These encompass biological factors like concealed/accelerated carcinogenesis through a bypassed adenoma stage and accelerated progression from adenomas. Alongside these, various colonoscopy-related factors may contribute to formation of CRCs under colonoscopy surveillance, like missed yet detectable (pre)cancerous lesions, detected yet incompletely removed (pre)cancerous lesions, and colonoscopy-induced carcinogenesis due to tumor cell reimplantation. In this comprehensive literature update, we reviewed these potential factors and evaluated their relevance to each MMR group in an attempt to raise further awareness and stimulate research regarding this conflicting phenomenon.
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Affiliation(s)
- Noah C Helderman
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Matthias Kloor
- Department of Applied Tumor Biology, Heidelberg University Hospital, Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Aysel Ahadova
- Department of Applied Tumor Biology, Heidelberg University Hospital, Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Maartje Nielsen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
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2
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Guo F, Meng H. Application of artificial intelligence in gastrointestinal endoscopy. Arab J Gastroenterol 2024; 25:93-96. [PMID: 38228443 DOI: 10.1016/j.ajg.2023.12.010] [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: 02/24/2023] [Revised: 09/06/2023] [Accepted: 12/30/2023] [Indexed: 01/18/2024]
Abstract
Endoscopy is an important method for diagnosing gastrointestinal (GI) diseases. In this study, we provide an overview of the advances in artificial intelligence (AI) technology in the field of GI endoscopy over recent years, including esophagus, stomach, large intestine, and capsule endoscopy (small intestine). AI-assisted endoscopy shows high accuracy, sensitivity, and specificity in the detection and diagnosis of GI diseases at all levels. Hence, AI will make a breakthrough in the field of GI endoscopy in the near future. However, AI technology currently has some limitations and is still in the preclinical stages.
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Affiliation(s)
- Fujia Guo
- The first Affiliated Hospital, Dalian Medical University, Dalian 116044, China
| | - Hua Meng
- The first Affiliated Hospital, Dalian Medical University, Dalian 116044, China.
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3
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Lee MCM, Parker CH, Liu LWC, Farahvash A, Jeyalingam T. Impact of study design on adenoma detection in the evaluation of artificial intelligence-aided colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2024; 99:676-687.e16. [PMID: 38272274 DOI: 10.1016/j.gie.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND AIMS Randomized controlled trials (RCTs) have reported that artificial intelligence (AI) improves endoscopic polyp detection. Different methodologies-namely, parallel and tandem designs-have been used to evaluate the efficacy of AI-assisted colonoscopy in RCTs. Systematic reviews and meta-analyses have reported a pooled effect that includes both study designs. However, it is unclear whether there are inconsistencies in the reported results of these 2 designs. Here, we aimed to determine whether study characteristics moderate between-trial differences in outcomes when evaluating the effectiveness of AI-assisted polyp detection. METHODS A systematic search of Ovid MEDLINE, Embase, Cochrane Central, Web of Science, and IEEE Xplore was performed through March 1, 2023, for RCTs comparing AI-assisted colonoscopy with routine high-definition colonoscopy in polyp detection. The primary outcome of interest was the impact of study type on the adenoma detection rate (ADR). Secondary outcomes included the impact of the study type on adenomas per colonoscopy and withdrawal time, as well as the impact of geographic location, AI system, and endoscopist experience on ADR. Pooled event analysis was performed using a random-effects model. RESULTS Twenty-four RCTs involving 17,413 colonoscopies (AI assisted: 8680; non-AI assisted: 8733) were included. AI-assisted colonoscopy improved overall ADR (risk ratio [RR], 1.24; 95% confidence interval [CI], 1.17-1.31; I2 = 53%; P < .001). Tandem studies collectively demonstrated improved ADR in AI-aided colonoscopies (RR, 1.18; 95% CI, 1.08-1.30; I2 = 0%; P < .001), as did parallel studies (RR, 1.26; 95% CI, 1.17-1.35; I2 = 62%; P < .001), with no statistical subgroup difference between study design. Both tandem and parallel study designs revealed improvement in adenomas per colonoscopy in AI-aided colonoscopies, but this improvement was more marked among tandem studies (P < .001). AI assistance significantly increased withdrawal times for parallel (P = .002), but not tandem, studies. ADR improvement was more marked among studies conducted in Asia compared to Europe and North America in a subgroup analysis (P = .007). Type of AI system used or endoscopist experience did not affect overall improvement in ADR. CONCLUSIONS Either parallel or tandem study design can capture the improvement in ADR resulting from the use of AI-assisted polyp detection systems. Tandem studies powered to detect differences in endoscopic performance through paired comparison may be a resource-efficient method of evaluating new AI-assisted technologies.
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Affiliation(s)
- Michelle C M Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colleen H Parker
- Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Louis W C Liu
- Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Armin Farahvash
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thurarshen Jeyalingam
- Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Toyoshima O, Nishizawa T, Hata K. Topic highlight on texture and color enhancement imaging in gastrointestinal diseases. World J Gastroenterol 2024; 30:1934-1940. [PMID: 38681121 PMCID: PMC11045492 DOI: 10.3748/wjg.v30.i14.1934] [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: 11/30/2023] [Revised: 02/03/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Olympus Corporation developed texture and color enhancement imaging (TXI) as a novel image-enhancing endoscopic technique. This topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting. A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate (ADR) and the mean number of adenomas per procedure (MAP) of TXI compared with those of white-light imaging (WLI) observation (58.7% vs 42.7%, adjusted relative risk 1.35, 95%CI: 1.17-1.56; 1.36 vs 0.89, adjusted incident risk ratio 1.48, 95%CI: 1.22-1.80, respectively). A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI (1.5 vs 1.0, adjusted odds ratio 1.4, 95%CI: 1.2-1.6; 58.2% vs 46.8%, 1.5, 1.0-2.3, respectively). A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure (0.29 vs 0.30, difference for non-inferiority -0.01, 95%CI: -0.10 to 0.08). A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis. A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI (0.71% vs 0.29%). A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI (69.2% vs 52.5% and 85.3% vs 78.7%, respectively). In conclusion, TXI can improve gastrointestinal lesion detection and qualitative diagnosis. Therefore, further studies on the efficacy of TXI in clinical practice are required.
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Affiliation(s)
- Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
| | - Keisuke Hata
- Department of Gastroenterology, Nihonbashi Muromachi Mitsui Tower Midtown Clinic, Tokyo 103-0022, Japan
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5
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Yadav A, Kumar A. Artificial intelligence in rectal cancer: What is the future? Artif Intell Cancer 2023; 4:11-22. [DOI: 10.35713/aic.v4.i2.11] [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: 07/15/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 12/07/2023] Open
Abstract
Colorectal cancer (CRC) is the third most prevalent cancer in both men and women, and it is the second leading cause of cancer-related deaths globally. Around 60%-70% of CRC patients are diagnosed at advanced stages, with nearly 20% having liver metastases. It is noteworthy that the 5-year survival rates decline significantly from 80%-90% for localized disease to a mere 10%-15% for patients with metastasis at the time of diagnosis. Early diagnosis, appropriate therapeutic strategy, accurate assessment of treatment response, and prognostication is essential for better outcome. There has been significant technological development in the last couple of decades to improve the outcome of rectal cancer including Artificial intelligence (AI). AI is a broad term used to describe the study of machines that mimic human intelligence, such as perceiving the environment, drawing logical conclusions from observations, and performing complex tasks. At present AI has demonstrated a promising role in early diagnosis, prognosis, and treatment outcomes for patients with rectal cancer, a limited role in surgical decision making, and had a bright future.
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Affiliation(s)
- Alka Yadav
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
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Kumarasamy G, Mohd Salim NH, Mohd Afandi NS, Hazlami Habib MA, Mat Amin ND, Ismail MN, Musa M. Glycoproteomics-based liquid biopsy: translational outlook for colorectal cancer clinical management in Southeast Asia. Future Oncol 2023; 19:2313-2332. [PMID: 37937446 DOI: 10.2217/fon-2023-0704] [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] [Indexed: 11/09/2023] Open
Abstract
Colorectal cancer (CRC) signifies a significant healthcare challenge in Southeast Asia. Despite advancements in screening approaches and treatment modalities, significant medical gaps remain, ranging from prevention and early diagnosis to determining targeted therapy and establishing personalized approaches to managing CRC. There is a need to expand more validated biomarkers in clinical practice. An advanced technique incorporating high-throughput mass spectrometry as a liquid biopsy to unravel a repertoire of glycoproteins and glycans would potentially drive the development of clinical tools for CRC screening, diagnosis and monitoring, and it can be further adapted to the existing standard-of-care procedure. Therefore this review offers a perspective on glycoproteomics-driven liquid biopsy and its potential integration into the clinical care of CRC in the southeast Asia region.
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Affiliation(s)
- Gaayathri Kumarasamy
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Pulau Pinang, 11800, Malaysia
| | - Nurul Hakimah Mohd Salim
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
| | - Nur Syafiqah Mohd Afandi
- Analytical Biochemistry Research Centre, Universiti Sains Malaysia, Bayan Lepas, Pulau Pinang, 11900, Malaysia
| | - Mohd Afiq Hazlami Habib
- Analytical Biochemistry Research Centre, Universiti Sains Malaysia, Bayan Lepas, Pulau Pinang, 11900, Malaysia
| | - Nor Datiakma Mat Amin
- Analytical Biochemistry Research Centre, Universiti Sains Malaysia, Bayan Lepas, Pulau Pinang, 11900, Malaysia
- Nature Products Division, Forest Research Institute Malaysia, Kepong, Selangor, 52109, Malaysia
| | - Mohd Nazri Ismail
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Pulau Pinang, 11800, Malaysia
- Analytical Biochemistry Research Centre, Universiti Sains Malaysia, Bayan Lepas, Pulau Pinang, 11900, Malaysia
| | - Marahaini Musa
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
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Vulpoi RA, Luca M, Ciobanu A, Olteanu A, Bărboi O, Iov DE, Nichita L, Ciortescu I, Cijevschi Prelipcean C, Ștefănescu G, Mihai C, Drug VL. The Potential Use of Artificial Intelligence in Irritable Bowel Syndrome Management. Diagnostics (Basel) 2023; 13:3336. [PMID: 37958232 PMCID: PMC10648815 DOI: 10.3390/diagnostics13213336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Irritable bowel syndrome (IBS) has a global prevalence of around 4.1% and is associated with a low quality of life and increased healthcare costs. Current guidelines recommend that IBS is diagnosed using the symptom-based Rome IV criteria. Despite this, when patients seek medical attention, they are usually over-investigated. This issue might be resolved by novel technologies in medicine, such as the use of Artificial Intelligence (AI). In this context, this paper aims to review AI applications in IBS. AI in colonoscopy proved to be useful in organic lesion detection and diagnosis and in objectively assessing the quality of the procedure. Only a recently published study talked about the potential of AI-colonoscopy in IBS. AI was also used to study biofilm characteristics in the large bowel and establish a potential relationship with IBS. Moreover, an AI algorithm was developed in order to correlate specific bowel sounds with IBS. In addition to that, AI-based smartphone applications have been developed to facilitate the monitoring of IBS symptoms. From a therapeutic standpoint, an AI system was created to recommend specific diets based on an individual's microbiota. In conclusion, future IBS diagnosis and treatment may benefit from AI.
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Affiliation(s)
- Radu Alexandru Vulpoi
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Mihaela Luca
- Institute of Computer Science, Romanian Academy-Iasi Branch, 700481 Iasi, Romania; (M.L.); (A.C.)
| | - Adrian Ciobanu
- Institute of Computer Science, Romanian Academy-Iasi Branch, 700481 Iasi, Romania; (M.L.); (A.C.)
| | - Andrei Olteanu
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Oana Bărboi
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Diana-Elena Iov
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Loredana Nichita
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Irina Ciortescu
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Cristina Cijevschi Prelipcean
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Gabriela Ștefănescu
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Cătălina Mihai
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Vasile Liviu Drug
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
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Ahamed MF, Syfullah MK, Sarkar O, Islam MT, Nahiduzzaman M, Islam MR, Khandakar A, Ayari MA, Chowdhury MEH. IRv2-Net: A Deep Learning Framework for Enhanced Polyp Segmentation Performance Integrating InceptionResNetV2 and UNet Architecture with Test Time Augmentation Techniques. SENSORS (BASEL, SWITZERLAND) 2023; 23:7724. [PMID: 37765780 PMCID: PMC10534485 DOI: 10.3390/s23187724] [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: 07/10/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
Colorectal polyps in the colon or rectum are precancerous growths that can lead to a more severe disease called colorectal cancer. Accurate segmentation of polyps using medical imaging data is essential for effective diagnosis. However, manual segmentation by endoscopists can be time-consuming, error-prone, and expensive, leading to a high rate of missed anomalies. To solve this problem, an automated diagnostic system based on deep learning algorithms is proposed to find polyps. The proposed IRv2-Net model is developed using the UNet architecture with a pre-trained InceptionResNetV2 encoder to extract most features from the input samples. The Test Time Augmentation (TTA) technique, which utilizes the characteristics of the original, horizontal, and vertical flips, is used to gain precise boundary information and multi-scale image features. The performance of numerous state-of-the-art (SOTA) models is compared using several metrics such as accuracy, Dice Similarity Coefficients (DSC), Intersection Over Union (IoU), precision, and recall. The proposed model is tested on the Kvasir-SEG and CVC-ClinicDB datasets, demonstrating superior performance in handling unseen real-time data. It achieves the highest area coverage in the area under the Receiver Operating Characteristic (ROC-AUC) and area under Precision-Recall (AUC-PR) curves. The model exhibits excellent qualitative testing outcomes across different types of polyps, including more oversized, smaller, over-saturated, sessile, or flat polyps, within the same dataset and across different datasets. Our approach can significantly minimize the number of missed rating difficulties. Lastly, a graphical interface is developed for producing the mask in real-time. The findings of this study have potential applications in clinical colonoscopy procedures and can serve based on further research and development.
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Affiliation(s)
- Md. Faysal Ahamed
- Department of Computer Science & Engineering, Rajshahi University of Engineering & Technology, Rajshahi 6204, Bangladesh; (M.F.A.); (M.R.I.)
| | - Md. Khalid Syfullah
- Department of Electrical & Computer Engineering, Rajshahi University of Engineering & Technology, Rajshahi 6204, Bangladesh; (M.K.S.); (O.S.); (M.N.)
| | - Ovi Sarkar
- Department of Electrical & Computer Engineering, Rajshahi University of Engineering & Technology, Rajshahi 6204, Bangladesh; (M.K.S.); (O.S.); (M.N.)
| | - Md. Tohidul Islam
- Department of Information & Communication Engineering, University of Rajshahi, Rajshahi 6205, Bangladesh;
| | - Md. Nahiduzzaman
- Department of Electrical & Computer Engineering, Rajshahi University of Engineering & Technology, Rajshahi 6204, Bangladesh; (M.K.S.); (O.S.); (M.N.)
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar;
| | - Md. Rabiul Islam
- Department of Computer Science & Engineering, Rajshahi University of Engineering & Technology, Rajshahi 6204, Bangladesh; (M.F.A.); (M.R.I.)
| | - Amith Khandakar
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar;
| | - Mohamed Arselene Ayari
- Department of Civil and environmental Engineering, Qatar University, Doha 2713, Qatar;
- Technology Innovation and Engineering Education Unit (TIEE), Qatar University, Doha 2713, Qatar
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Bai J, Liu K, Gao L, Zhao X, Zhu S, Han Y, Liu Z. Computer-aided diagnosis in predicting the invasion depth of early colorectal cancer: a systematic review and meta-analysis of diagnostic test accuracy. Surg Endosc 2023; 37:6627-6639. [PMID: 37430125 DOI: 10.1007/s00464-023-10223-6] [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: 03/12/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Endoscopic resection (ER) is widely applied to treat early colorectal cancer (CRC). Predicting the invasion depth of early CRC is critical in determining treatment strategies. The use of computer-aided diagnosis (CAD) algorithms could theoretically make accurate and objective predictions regarding the suitability of lesions for ER indication based on invasion depth. This study aimed to assess diagnostic test accuracy of CAD algorithms in predicting the invasion depth of early CRC and to compare the performance between the CAD algorithms and endoscopists. METHODS Multiple databases were searched until June 30, 2022 for studies that evaluated the diagnostic performance of CAD algorithms for invasion depth of CRC. Meta-analysis of diagnostic test accuracy using a bivariate mixed-effects model was performed. RESULTS Ten studies consisting of 13 arms (13,918 images from 1472 lesions) were included. Due to significant heterogeneity, studies were stratified into Japan/Korea-based or China-based studies. For the former, the area under the curve (AUC), sensitivity, and specificity of the CAD algorithms were 0.89 (95% CI 0.86-0.91), 62% (95% CI 50-72%), and 96% (95% CI 93-98%), respectively. For the latter, AUC, sensitivity, and specificity were 0.94 (95% CI 0.92-0.96), 88% (95% CI 78-94%), and 88% (95% CI 80-93%), respectively. The performance of the CAD algorithms in Japan/Korea-based studies was not significantly different from that of all endoscopists (0.88 vs. 0.91, P = 0.10) but was inferior to that of expert endoscopists (0.88 vs. 0.92, P = 0.03). The performance of the CAD algorithms in China-based studies was better than that of all endoscopists (0.94 vs. 0.90, P = 0.01). CONCLUSION The CAD algorithms showed comparable accuracy for prediction of invasion depth of early CRC compared to all endoscopists, which was still lower than expert endoscopists in diagnostic accuracy; more improvements should be achieved before it can be extensively applied to clinical practice.
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Affiliation(s)
- Jiawei Bai
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
- School of Medicine, Yan'an University, Yan'an, China
| | - Kai Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Li Gao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xin Zhao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Shaohua Zhu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Ying Han
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Zhiguo Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
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Allgaier J, Mulansky L, Draelos RL, Pryss R. How does the model make predictions? A systematic literature review on the explainability power of machine learning in healthcare. Artif Intell Med 2023; 143:102616. [PMID: 37673561 DOI: 10.1016/j.artmed.2023.102616] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/22/2023] [Accepted: 05/15/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Medical use cases for machine learning (ML) are growing exponentially. The first hospitals are already using ML systems as decision support systems in their daily routine. At the same time, most ML systems are still opaque and it is not clear how these systems arrive at their predictions. METHODS In this paper, we provide a brief overview of the taxonomy of explainability methods and review popular methods. In addition, we conduct a systematic literature search on PubMed to investigate which explainable artificial intelligence (XAI) methods are used in 450 specific medical supervised ML use cases, how the use of XAI methods has emerged recently, and how the precision of describing ML pipelines has evolved over the past 20 years. RESULTS A large fraction of publications with ML use cases do not use XAI methods at all to explain ML predictions. However, when XAI methods are used, open-source and model-agnostic explanation methods are more commonly used, with SHapley Additive exPlanations (SHAP) and Gradient Class Activation Mapping (Grad-CAM) for tabular and image data leading the way. ML pipelines have been described in increasing detail and uniformity in recent years. However, the willingness to share data and code has stagnated at about one-quarter. CONCLUSIONS XAI methods are mainly used when their application requires little effort. The homogenization of reports in ML use cases facilitates the comparability of work and should be advanced in the coming years. Experts who can mediate between the worlds of informatics and medicine will become more and more in demand when using ML systems due to the high complexity of the domain.
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Affiliation(s)
- Johannes Allgaier
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg (JMU), Germany.
| | - Lena Mulansky
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg (JMU), Germany.
| | | | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg (JMU), Germany.
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11
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Arif AA, Jiang SX, Byrne MF. Artificial intelligence in endoscopy: Overview, applications, and future directions. Saudi J Gastroenterol 2023; 29:269-277. [PMID: 37787347 PMCID: PMC10644999 DOI: 10.4103/sjg.sjg_286_23] [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: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/15/2023] Open
Abstract
Since the emergence of artificial intelligence (AI) in medicine, endoscopy applications in gastroenterology have been at the forefront of innovations. The ever-increasing number of studies necessitates the need to organize and classify applications in a useful way. Separating AI capabilities by computer aided detection (CADe), diagnosis (CADx), and quality assessment (CADq) allows for a systematic evaluation of each application. CADe studies have shown promise in accurate detection of esophageal, gastric and colonic neoplasia as well as identifying sources of bleeding and Crohn's disease in the small bowel. While more advanced CADx applications employ optical biopsies to give further information to characterize neoplasia and grade inflammatory disease, diverse CADq applications ensure quality and increase the efficiency of procedures. Future applications show promise in advanced therapeutic modalities and integrated systems that provide multimodal capabilities. AI is set to revolutionize clinical decision making and performance of endoscopy.
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Affiliation(s)
- Arif A. Arif
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shirley X. Jiang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michael F. Byrne
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Satisfai Health, Vancouver, BC, Canada
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12
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Taghiakbari M, Coman DE, Takla M, Barkun A, Bouin M, Bouchard S, Deslandres E, Sidani S, von Renteln D. Measuring the observer (Hawthorne) effect on adenoma detection rates. Endosc Int Open 2023; 11:E908-E919. [PMID: 37810903 PMCID: PMC10558259 DOI: 10.1055/a-2131-4797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 07/13/2023] [Indexed: 10/10/2023] Open
Abstract
Background and study aims An independent observer can improve procedural quality. We evaluated the impact of the observer (Hawthorne effect) on important quality metrics during colonoscopies. Patients and Methods In a single-center comparative study, consecutive patients undergoing routine screening or diagnostic colonoscopy were prospectively enrolled. In the index group, all procedural steps and quality metrics were observed and documented, and the procedure was video recorded by an independent research assistant. In the reference group, colonoscopies were performed without independent observation. Colonoscopy quality metrics such as polyp, adenoma, serrated lesions, and advanced adenoma detection rates (PDR, ADR, SLDR, AADR) were compared. The probabilities of increased quality metrics were evaluated through regression analyses weighted by the inversed probability of observation during the procedure. Results We included 327 index individuals and 360 referents in the final analyses. The index group had significantly higher PDRs (62.4% vs. 53.1%, P =0.02) and ADRs (39.4% vs. 28.3%, P =0.002) compared with the reference group. The SLDR and AADR were not significantly increased. After adjusting for potential confounders, the ADR and SLDR were 50% (relative risk [RR] 1.51; 95%, CI 1.05-2.17) and more than twofold (RR 2.17; 95%, CI 1.05-4.47) more likely to be higher in the index group than in the reference group. Conclusions The presence of an independent observer documenting colonoscopy quality metrics and video recording the colonoscopy resulted in a significant increase in ADR and other quality metrics. The Hawthorne effect should be considered an alternative strategy to advanced devices to improve colonoscopy quality in practice.
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Affiliation(s)
- Mahsa Taghiakbari
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Diana Elena Coman
- Internal Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Mark Takla
- Faculty of Medicine, University of Montreal Hospital Centre, Montreal, Canada
| | - Alan Barkun
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Mickael Bouin
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Simon Bouchard
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
- Gastroenterology, Centre de Recherche de l'Université de Montréal (CHUM), Montreal, Canada
| | - Eric Deslandres
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
- Gastroenterology, Centre de Recherche de l'Université de Montréal (CHUM), Montreal, Canada
| | - Sacha Sidani
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
- Gastroenterology, Centre de Recherche de l'Université de Montréal (CHUM), Montreal, Canada
| | - Daniel von Renteln
- Gastroenterology, Centre Hospitialier de l'Université de Montréal (CHUM), Montreal, Canada
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13
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Taghiakbari M, Hamidi Ghalehjegh S, Jehanno E, Berthier T, di Jorio L, Ghadakzadeh S, Barkun A, Takla M, Bouin M, Deslandres E, Bouchard S, Sidani S, Bengio Y, von Renteln D. Automated Detection of Anatomical Landmarks During Colonoscopy Using a Deep Learning Model. J Can Assoc Gastroenterol 2023; 6:145-151. [PMID: 37538187 PMCID: PMC10395661 DOI: 10.1093/jcag/gwad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background and aims Identification and photo-documentation of the ileocecal valve (ICV) and appendiceal orifice (AO) confirm completeness of colonoscopy examinations. We aimed to develop and test a deep convolutional neural network (DCNN) model that can automatically identify ICV and AO, and differentiate these landmarks from normal mucosa and colorectal polyps. Methods We prospectively collected annotated full-length colonoscopy videos of 318 patients undergoing outpatient colonoscopies. We created three nonoverlapping training, validation, and test data sets with 25,444 unaltered frames extracted from the colonoscopy videos showing four landmarks/image classes (AO, ICV, normal mucosa, and polyps). A DCNN classification model was developed, validated, and tested in separate data sets of images containing the four different landmarks. Results After training and validation, the DCNN model could identify both AO and ICV in 18 out of 21 patients (85.7%). The accuracy of the model for differentiating AO from normal mucosa, and ICV from normal mucosa were 86.4% (95% CI 84.1% to 88.5%), and 86.4% (95% CI 84.1% to 88.6%), respectively. Furthermore, the accuracy of the model for differentiating polyps from normal mucosa was 88.6% (95% CI 86.6% to 90.3%). Conclusion This model offers a novel tool to assist endoscopists with automated identification of AO and ICV during colonoscopy. The model can reliably distinguish these anatomical landmarks from normal mucosa and colorectal polyps. It can be implemented into automated colonoscopy report generation, photo-documentation, and quality auditing solutions to improve colonoscopy reporting quality.
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Affiliation(s)
- Mahsa Taghiakbari
- Faculty of Medicine, Department of Biomedical Sciences, University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Division of Gastroenterology, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | | | - Emmanuel Jehanno
- Department of Artificial Intelligence, Imagia Canexia Health Inc., Montreal, Canada
| | - Tess Berthier
- Department of Artificial Intelligence, Imagia Canexia Health Inc., Montreal, Canada
| | - Lisa di Jorio
- Department of Artificial Intelligence, Imagia Canexia Health Inc., Montreal, Canada
| | - Saber Ghadakzadeh
- Department of Artificial Intelligence, Imagia Canexia Health Inc., Montreal, Canada
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Mark Takla
- Faculty of Medicine, Department of Biomedical Sciences, University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Division of Gastroenterology, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Mickael Bouin
- Department of Medicine, Division of Gastroenterology, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
- Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Eric Deslandres
- Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Simon Bouchard
- Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Sacha Sidani
- Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Yoshua Bengio
- Faculty of Medicine, Department of Biomedical Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Daniel von Renteln
- Department of Medicine, Division of Gastroenterology, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
- Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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14
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Houwen BBSL, Hazewinkel Y, Giotis I, Vleugels JLA, Mostafavi NS, van Putten P, Fockens P, Dekker E. Computer-aided diagnosis for optical diagnosis of diminutive colorectal polyps including sessile serrated lesions: a real-time comparison with screening endoscopists. Endoscopy 2023; 55:756-765. [PMID: 36623839 PMCID: PMC10374350 DOI: 10.1055/a-2009-3990] [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] [Received: 07/13/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND : We aimed to compare the accuracy of the optical diagnosis of diminutive colorectal polyps, including sessile serrated lesions (SSLs), between a computer-aided diagnosis (CADx) system and endoscopists during real-time colonoscopy. METHODS : We developed the POLyp Artificial Recognition (POLAR) system, which was capable of performing real-time characterization of diminutive colorectal polyps. For pretraining, the Microsoft-COCO dataset with over 300 000 nonpolyp object images was used. For training, eight hospitals prospectively collected 2637 annotated images from 1339 polyps (i. e. publicly available online POLAR database). For clinical validation, POLAR was tested during colonoscopy in patients with a positive fecal immunochemical test (FIT), and compared with the performance of 20 endoscopists from eight hospitals. Endoscopists were blinded to the POLAR output. Primary outcome was the comparison of accuracy of the optical diagnosis of diminutive colorectal polyps between POLAR and endoscopists (neoplastic [adenomas and SSLs] versus non-neoplastic [hyperplastic polyps]). Histopathology served as the reference standard. RESULTS : During clinical validation, 423 diminutive polyps detected in 194 FIT-positive individuals were included for analysis (300 adenomas, 41 SSLs, 82 hyperplastic polyps). POLAR distinguished neoplastic from non-neoplastic lesions with 79 % accuracy, 89 % sensitivity, and 38 % specificity. The endoscopists achieved 83 % accuracy, 92 % sensitivity, and 44 % specificity. The optical diagnosis accuracy between POLAR and endoscopists was not significantly different (P = 0.10). The proportion of polyps in which POLAR was able to provide an optical diagnosis was 98 % (i. e. success rate). CONCLUSIONS : We developed a CADx system that differentiated neoplastic from non-neoplastic diminutive polyps during endoscopy, with an accuracy comparable to that of screening endoscopists and near-perfect success rate.
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Affiliation(s)
- Britt B. S. L. Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Radboud University of Nijmegen, Nijmegen, The Netherlands
| | | | - Jasper L. A. Vleugels
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nahid S. Mostafavi
- Department of Gastroenterology and Hepatology, Subdivision Statistics, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul van Putten
- Department of Gastroenterology and Hepatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Bergman Clinics Maag and Darm Amsterdam, Amsterdam, The Netherlands
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15
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Shahsavari D, Waqar M, Thoguluva Chandrasekar V. Image enhanced colonoscopy: updates and prospects-a review. Transl Gastroenterol Hepatol 2023; 8:26. [PMID: 37601740 PMCID: PMC10432234 DOI: 10.21037/tgh-23-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Colonoscopy has been proven to be a successful approach in both identifying and preventing colorectal cancer. The incorporation of advanced imaging technologies, such as image-enhanced endoscopy (IEE), plays a vital role in real-time diagnosis. The advancements in endoscopic imaging technology have been continuous, from replacing fiber optics with charge-coupled devices to the introduction of chromoendoscopy in the 1970s. Recent technological advancements include "push-button" technologies like autofluorescence imaging (AFI), narrowed-spectrum endoscopy, and confocal laser endomicroscopy (CLE). Dye-based chromoendoscopy (DCE) is falling out of favor due to the longer time required for application and removal of the dye and the difficulty of identifying lesions in certain situations. Narrow band imaging (NBI) is a technology that filters the light used for illumination leading to improved contrast and better visibility of structures on the mucosal surface and has shown a consistently higher adenoma detection rate (ADR) compared to white light endoscopy. CLE has high sensitivity and specificity for polyp detection and characterization, and several classifications have been developed for accurate identification of normal, regenerative, and dysplastic epithelium. Other IEE technologies, such as blue laser imaging (BLI), linked-color imaging (LCI), i-SCAN, and AFI, have also shown promise in improving ADR and characterizing polyps. New technologies, such as Optivista, red dichromatic imaging (RDI), texture and color enhancement imaging (TXI), and computer-aided detection (CAD) using artificial intelligence (AI), are being developed to improve polyp detection and pathology prediction prior to widespread use in clinical practice.
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16
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Cherubini A, Dinh NN. A Review of the Technology, Training, and Assessment Methods for the First Real-Time AI-Enhanced Medical Device for Endoscopy. Bioengineering (Basel) 2023; 10:bioengineering10040404. [PMID: 37106592 PMCID: PMC10136070 DOI: 10.3390/bioengineering10040404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/25/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Artificial intelligence (AI) has the potential to assist in endoscopy and improve decision making, particularly in situations where humans may make inconsistent judgments. The performance assessment of the medical devices operating in this context is a complex combination of bench tests, randomized controlled trials, and studies on the interaction between physicians and AI. We review the scientific evidence published about GI Genius, the first AI-powered medical device for colonoscopy to enter the market, and the device that is most widely tested by the scientific community. We provide an overview of its technical architecture, AI training and testing strategies, and regulatory path. In addition, we discuss the strengths and limitations of the current platform and its potential impact on clinical practice. The details of the algorithm architecture and the data that were used to train the AI device have been disclosed to the scientific community in the pursuit of a transparent AI. Overall, the first AI-enabled medical device for real-time video analysis represents a significant advancement in the use of AI for endoscopies and has the potential to improve the accuracy and efficiency of colonoscopy procedures.
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Affiliation(s)
- Andrea Cherubini
- Cosmo Intelligent Medical Devices, D02KV60 Dublin, Ireland
- Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milano, Italy
| | - Nhan Ngo Dinh
- Cosmo Intelligent Medical Devices, D02KV60 Dublin, Ireland
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17
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Chadebecq F, Lovat LB, Stoyanov D. Artificial intelligence and automation in endoscopy and surgery. Nat Rev Gastroenterol Hepatol 2023; 20:171-182. [PMID: 36352158 DOI: 10.1038/s41575-022-00701-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/10/2022]
Abstract
Modern endoscopy relies on digital technology, from high-resolution imaging sensors and displays to electronics connecting configurable illumination and actuation systems for robotic articulation. In addition to enabling more effective diagnostic and therapeutic interventions, the digitization of the procedural toolset enables video data capture of the internal human anatomy at unprecedented levels. Interventional video data encapsulate functional and structural information about a patient's anatomy as well as events, activity and action logs about the surgical process. This detailed but difficult-to-interpret record from endoscopic procedures can be linked to preoperative and postoperative records or patient imaging information. Rapid advances in artificial intelligence, especially in supervised deep learning, can utilize data from endoscopic procedures to develop systems for assisting procedures leading to computer-assisted interventions that can enable better navigation during procedures, automation of image interpretation and robotically assisted tool manipulation. In this Perspective, we summarize state-of-the-art artificial intelligence for computer-assisted interventions in gastroenterology and surgery.
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Affiliation(s)
- François Chadebecq
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Laurence B Lovat
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
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18
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Revealing the Boundaries of Selected Gastro-Intestinal (GI) Organs by Implementing CNNs in Endoscopic Capsule Images. Diagnostics (Basel) 2023; 13:diagnostics13050865. [PMID: 36900009 PMCID: PMC10000441 DOI: 10.3390/diagnostics13050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE The detection of where an organ starts and where it ends is achievable and, since this information can be delivered in real time, it could be quite important for several reasons. For one, by having the practical knowledge of the Wireless Endoscopic Capsule (WEC) transition through an organ's domain, we are able to align and control the endoscopic operation with any other possible protocol, i.e., delivering some form of treatment on the spot. Another is having greater anatomical topography information per session, therefore treating the individual in detail (not "in general"). Even the fact that by gathering more accurate information for a patient by merely implementing clever software procedures is a task worth exploiting, since the problems we have to overcome in real-time processing of the capsule findings (i.e., wireless transfer of images to another unit that will apply the necessary real time computations) are still challenging. This study proposes a computer-aided detection (CAD) tool, a CNN algorithm deployed to run on field programmable gate array (FPGA), able to automatically track the capsule transitions through the entrance (gate) of esophagus, stomach, small intestine and colon, in real time. The input data are the wireless transmitted image shots of the capsule's camera (while the endoscopy capsule is operating). METHODS We developed and evaluated three distinct multiclass classification CNNs, trained on the same dataset of total 5520 images extracted by 99 capsule videos (total 1380 frames from each organ of interest). The proposed CNNs differ in size and number of convolution filters. The confusion matrix is obtained by training each classifier and evaluating the trained model on an independent test dataset comprising 496 images extracted by 39 capsule videos, 124 from each GI organ. The test dataset was further evaluated by one endoscopist, and his findings were compared with CNN-based results. The statistically significant of predictions between the four classes of each model and the comparison between the three distinct models is evaluated by calculating the p-values and chi-square test for multi class. The comparison between the three models is carried out by calculating the macro average F1 score and Mattheus correlation coefficient (MCC). The quality of the best CNN model is estimated by calculations of sensitivity and specificity. RESULTS Our experimental results of independent validation demonstrate that the best of our developed models addressed this topological problem by exhibiting an overall sensitivity (96.55%) and specificity of (94.73%) in the esophagus, (81.08% sensitivity and 96.55% specificity) in the stomach, (89.65% sensitivity and 97.89% specificity) in the small intestine and (100% sensitivity and 98.94% specificity) in the colon. The average macro accuracy is 95.56%, the average macro sensitivity is 91.82%.
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19
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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.
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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
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20
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The effectiveness of real-time computer-aided and quality control systems in colorectal adenoma and polyp detection during colonoscopies: a meta-analysis. Ann Med Surg (Lond) 2023; 85:80-91. [PMID: 36845807 PMCID: PMC9949794 DOI: 10.1097/ms9.0000000000000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/08/2022] [Indexed: 02/28/2023] Open
Abstract
This meta-analysis aims to quantify the effectiveness of artificial intelligence (AI)-supported colonoscopy compared to standard colonoscopy in adenoma detection rate (ADR) differences with the use of computer-aided detection and quality control systems. Moreover, the polyp detection rate (PDR) intergroup differences and withdrawal times will be analyzed. Methods This study was conducted adhering to PRISMA guidelines. Studies were searched across PubMed, CINAHL, EMBASE, Scopus, Cochrane, and Web of Science. Keywords including the following 'Artificial Intelligence, Polyp, Adenoma, Detection, Rate, Colonoscopy, Colorectal, Colon, Rectal' were used. Odds ratio (OR) applying 95% CI for PDR and ADR were computed. SMD with 95% CI for withdrawal times were computed using RevMan 5.4.1 (Cochrane). The risk of bias was assessed using the RoB 2 tool. Results Of 2562 studies identified, 11 trials were included comprising 6856 participants. Of these, 57.4% participants were in the AI group and 42.6% individuals were in in the standard group. ADR was higher in the AI group compared to the standard of care group (OR=1.51, P=0.003). PDR favored the intervened group compared to the standard group (OR=1.89, P<0.0001). A medium measure of effect was found for withdrawal times (SMD=0.25, P<0.0001), therefore with limited practical applications. Conclusion AI-supported colonoscopies improve PDR and ADR; however, no noticeable worsening of withdrawal times is noted. Colorectal cancers are highly preventable if diagnosed early-on. With AI-assisted tools in clinical practice, there is a strong potential to reduce the incidence rates of cancers in the near future.
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21
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von Renteln D, Byrne MF, Wong C, Menard C, Donnellan F, Barkun A. Implementation of Artificial Intelligence-Assisted Endoscopy Across Canada-The CAG Artificial Intelligence Special Interest Group. J Can Assoc Gastroenterol 2022; 6:5-7. [PMID: 36789145 PMCID: PMC9915053 DOI: 10.1093/jcag/gwac030] [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: 11/07/2022] Open
Affiliation(s)
- Daniel von Renteln
- Correspondence: Daniel von Renteln, MD, Department of Medicine, Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), 900 rue St-Denis, Montreal, Quebec H2X 0A9, Canada, e-mail:
| | - Michael F Byrne
- Division of Gastroenterology, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Clarence Wong
- Division of Gastroenterology, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Charles Menard
- Division of Gastroenterology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Fergal Donnellan
- Division of Gastroenterology, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan Barkun
- Division of Gastroenterology and Hepatology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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22
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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] [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.
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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.
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23
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Teoh AYB. Will robots take over our jobs as endoscopists? Gastrointest Endosc 2022; 96:148-149. [PMID: 35545471 DOI: 10.1016/j.gie.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR
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24
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Vulpoi RA, Luca M, Ciobanu A, Olteanu A, Barboi OB, Drug VL. Artificial Intelligence in Digestive Endoscopy—Where Are We and Where Are We Going? Diagnostics (Basel) 2022; 12:diagnostics12040927. [PMID: 35453975 PMCID: PMC9029251 DOI: 10.3390/diagnostics12040927] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Artificial intelligence, a computer-based concept that tries to mimic human thinking, is slowly becoming part of the endoscopy lab. It has developed considerably since the first attempt at developing an automated medical diagnostic tool, today being adopted in almost all medical fields, digestive endoscopy included. The detection rate of preneoplastic lesions (i.e., polyps) during colonoscopy may be increased with artificial intelligence assistance. It has also proven useful in detecting signs of ulcerative colitis activity. In upper digestive endoscopy, deep learning models may prove to be useful in the diagnosis and management of upper digestive tract diseases, such as gastroesophageal reflux disease, Barrett’s esophagus, and gastric cancer. As is the case with all new medical devices, there are challenges in the implementation in daily medical practice. The regulatory, economic, organizational culture, and language barriers between humans and machines are a few of them. Even so, many devices have been approved for use by their respective regulators. Future studies are currently striving to develop deep learning models that can replicate a growing amount of human brain activity. In conclusion, artificial intelligence may become an indispensable tool in digestive endoscopy.
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Affiliation(s)
- Radu-Alexandru Vulpoi
- Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania; (R.-A.V.); (A.O.); (V.L.D.)
| | - Mihaela Luca
- Institute of Computer Science, Romanian Academy—Iași Branch, 700481 Iași, Romania; (M.L.); (A.C.)
| | - Adrian Ciobanu
- Institute of Computer Science, Romanian Academy—Iași Branch, 700481 Iași, Romania; (M.L.); (A.C.)
| | - Andrei Olteanu
- Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania; (R.-A.V.); (A.O.); (V.L.D.)
| | - Oana-Bogdana Barboi
- Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania; (R.-A.V.); (A.O.); (V.L.D.)
- Correspondence: ; Tel.: +40-74-345-5012
| | - Vasile Liviu Drug
- Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania; (R.-A.V.); (A.O.); (V.L.D.)
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