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Savino A, Rondonotti E, Rocchetto S, Piagnani A, Bina N, Di Domenico P, Segatta F, Radaelli F. GI genius endoscopy module: a clinical profile. Expert Rev Med Devices 2024; 21:359-372. [PMID: 38618982 DOI: 10.1080/17434440.2024.2342508] [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: 10/31/2023] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The identification of early-stage colorectal cancers (CRC) and the resection of pre-cancerous neoplastic lesions through colonoscopy allows to decrease both CRC incidence and mortality. However, colonoscopy miss rates up to 26% for adenomas and 9% for advanced adenomas have been reported. In recent years, artificial intelligence (AI) systems have been emerging as easy-to-use tools, potentially lowering the risk of missing lesions. AREAS COVERED This review paper focuses on GI Genius device (Medtronic Co. Minneapolis, MN, U.S.A.) a computer-assisted tool designed to assist endoscopists during standard white-light colonoscopies in detecting mucosal lesions. EXPERT OPINION Randomized controlled trials (RCTs) suggest that GI Genius is a safe and effective tool for improving adenoma detection, especially in CRC screening and surveillance colonoscopies. However, its impact seems to be less significant among experienced endoscopists and in real-world clinical scenarios compared to the controlled conditions of RCTs. Furthermore, it appears that GI Genius mainly enhances the detection of non-advanced, small polyps, but does not significantly impact the identification of advanced and difficult-to-detect adenoma. When using GI Genius, no complications were documented. Only a small number of studies reported an increased in withdrawal time or the removal of non-neoplastic lesions.
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Affiliation(s)
- Alberto Savino
- Division of Gastroenterology, Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Simone Rocchetto
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Alessandra Piagnani
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Niccolò Bina
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - Pasquale Di Domenico
- Gastrointestinal Unit, Department of Medicine, Surgery & Dentistry Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Francesco Segatta
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Gastroenterology and Hepatology, University of Milan, Milan, Italy
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Hookey L. "AI for the new GI": What role does artificial intelligence have in early colonoscopy training? Gastrointest Endosc 2024; 99:100-101. [PMID: 38097302 DOI: 10.1016/j.gie.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Lawrence Hookey
- Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Nagai M, Suzuki S, Minato Y, Ishibashi F, Mochida K, Ohata K, Morishita T. Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials. Clin Endosc 2023; 56:553-562. [PMID: 37491990 PMCID: PMC10565430 DOI: 10.5946/ce.2023.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 07/27/2023] Open
Abstract
Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrowband wavelength light, such as narrowband imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To better understand the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.
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Affiliation(s)
- Mizuki Nagai
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Yohei Minato
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Ken Ohata
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tetsuo Morishita
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
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Baumer S, Streicher K, Alqahtani SA, Brookman-Amissah D, Brunner M, Federle C, Muehlenberg K, Pfeifer L, Salzberger A, Schorr W, Zustin J, Pech O. Accuracy of polyp characterization by artificial intelligence and endoscopists: a prospective, non-randomized study in a tertiary endoscopy center. Endosc Int Open 2023; 11:E818-E828. [PMID: 37727511 PMCID: PMC10506867 DOI: 10.1055/a-2096-2960] [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: 02/17/2023] [Accepted: 05/08/2023] [Indexed: 09/21/2023] Open
Abstract
Background and study aims Artificial intelligence (AI) in gastrointestinal endoscopy is developing very fast. Computer-aided detection of polyps and computer-aided diagnosis (CADx) for polyp characterization are available now. This study was performed to evaluate the diagnostic performance of a new commercially available CADx system in clinical practice. Patients and methods This prospective, non-randomized study was performed at a tertiary academic endoscopy center from March to August 2022. We included patients receiving a colonoscopy. Polypectomy had to be performed in all polyps. Every patient was examined concurrently by an endoscopist and AI using two opposing screens. The AI system, overseen by a second observer, was not visible to the endoscopist. The primary outcome was accuracy of the AI classifying the polyps into "neoplastic" and "non-neoplastic." The secondary outcome was accuracy of the classification by the endoscopists. Sessile serrated lesions were classified as neoplastic. Results We included 156 patients (mean age 65; 57 women) with 262 polyps ≤10 mm. Eighty-four were hyperplastic polyps (32.1%), 158 adenomas (60.3%), seven sessile serrated lesions (2.7%) and 13 other entities (normal/inflammatory colonmucosa, lymphoidic polyp) (4.9%) on histological diagnosis. Sensitivity, specificity and accuracy of AI were 89.70% (95% confidence interval [CI]: 84.02%-93.88%), 75.26% (95% CI: 65.46%-83.46%) and 84.35% (95% CI:79.38%-88.53%), respectively. Sensitivity, specificity and accuracy for less experienced endoscopists (2-5 years of endoscopy) were 95.56% (95% CI: 84.85%-99.46%), 61.54% (95% CI: 40.57%-79.77%) and 83.10% (95% CI: 72.34%-90.95%) and for experienced endoscopists 90.83% (95% CI: 84.19%-95.33%), 71.83% (95% CI: 59.90%-81.87%) and 83.77% (95% CI: 77.76%-88.70%), respectively. Conclusion Accuracy for polyp characterization by a new commercially available AI system is high, but does not fulfill the criteria for a "resect-and-discard" strategy.
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Affiliation(s)
- Sebastian Baumer
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Kilian Streicher
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Saleh A. Alqahtani
- Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Dominic Brookman-Amissah
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Monika Brunner
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Christoph Federle
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Klaus Muehlenberg
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Lukas Pfeifer
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Andrea Salzberger
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Wolfgang Schorr
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Jozef Zustin
- Private Practice, Histopathology Service Private Practice, Regensburg, Germany
- Gerhard-Domagk-Institute of Pathology, Universitätsklinikum Münster, Munster, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
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Liao WC, Mukundan A, Sadiaza C, Tsao YM, Huang CW, Wang HC. Systematic meta-analysis of computer-aided detection to detect early esophageal cancer using hyperspectral imaging. BIOMEDICAL OPTICS EXPRESS 2023; 14:4383-4405. [PMID: 37799695 PMCID: PMC10549751 DOI: 10.1364/boe.492635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 10/07/2023]
Abstract
One of the leading causes of cancer deaths is esophageal cancer (EC) because identifying it in early stage is challenging. Computer-aided diagnosis (CAD) could detect the early stages of EC have been developed in recent years. Therefore, in this study, complete meta-analysis of selected studies that only uses hyperspectral imaging to detect EC is evaluated in terms of their diagnostic test accuracy (DTA). Eight studies are chosen based on the Quadas-2 tool results for systematic DTA analysis, and each of the methods developed in these studies is classified based on the nationality of the data, artificial intelligence, the type of image, the type of cancer detected, and the year of publishing. Deeks' funnel plot, forest plot, and accuracy charts were made. The methods studied in these articles show the automatic diagnosis of EC has a high accuracy, but external validation, which is a prerequisite for real-time clinical applications, is lacking.
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Affiliation(s)
- Wei-Chih Liao
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Arvind Mukundan
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi 62102, Taiwan
| | - Cleorita Sadiaza
- Department of Mechanical Engineering, Far Eastern University, P. Paredes St., Sampaloc, Manila, 1015, Philippines
| | - Yu-Ming Tsao
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi 62102, Taiwan
| | - Chien-Wei Huang
- Department of Gastroenterology, Kaohsiung Armed Forces General Hospital, 2, Zhongzheng 1st.Rd., Lingya District, Kaohsiung City 80284, Taiwan
- Department of Nursing, Tajen University, 20, Weixin Rd., Yanpu Township, Pingtung County 90741, Taiwan
| | - Hsiang-Chen Wang
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi 62102, Taiwan
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan
- Director of Technology Development, Hitspectra Intelligent Technology Co., Ltd., 4F., No. 2, Fuxing 4th Rd., Qianzhen Dist., Kaohsiung City 80661, Taiwan
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Koh FH, Ladlad J, Teo EK, Lin CL, Foo FJ. Real-time artificial intelligence (AI)-aided endoscopy improves adenoma detection rates even in experienced endoscopists: a cohort study in Singapore. Surg Endosc 2023; 37:165-171. [PMID: 35882667 PMCID: PMC9321269 DOI: 10.1007/s00464-022-09470-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/10/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Colonoscopy is a mainstay to detect premalignant neoplastic lesions in the colon. Real-time Artificial Intelligence (AI)-aided colonoscopy purportedly improves the polyp detection rate, especially for small flat lesions. The aim of this study is to evaluate the performance of real-time AI-aided colonoscopy in the detection of colonic polyps. METHODS A prospective single institution cohort study was conducted in Singapore. All real-time AI-aided colonoscopies, regardless of indication, performed by specialist-grade endoscopists were anonymously recorded from July to September 2021 and reviewed by 2 independent authors (FHK, JL). Sustained detection of an area by the program was regarded as a "hit". Histology for the polypectomies were reviewed to determine adenoma detection rate (ADR). Individual endoscopist's performance with AI were compared against their baseline performance without AI endoscopy. RESULTS A total of 24 (82.8%) endoscopists participated with 18 (62.1%) performing ≥ 5 AI-aided colonoscopies. Of the 18, 72.2% (n = 13) were general surgeons. During that 3-months period, 487 "hits" encountered in 298 colonoscopies. Polypectomies were performed for 51.3% and 68.4% of these polypectomies were adenomas on histology. The post-intervention median ADR was 30.4% was higher than the median baseline polypectomy rate of 24.3% (p = 0.02). Of the adenomas excised, 14 (5.6%) were sessile serrated adenomas. Of those who performed ≥ 5 AI-aided colonoscopies, 13 (72.2%) had an improvement of ADR compared to their polypectomy rate before the introduction of AI, of which 2 of them had significant improvement. CONCLUSIONS Real-time AI-aided colonoscopy have the potential to improved ADR even for experienced endoscopists and would therefore, improve the quality of colonoscopy.
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Affiliation(s)
- Frederick H. Koh
- grid.508163.90000 0004 7665 4668Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, 110 Sengkang East Way, Singapore, 544886 Singapore
| | - Jasmine Ladlad
- grid.508163.90000 0004 7665 4668Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, 110 Sengkang East Way, Singapore, 544886 Singapore
| | | | - Eng-Kiong Teo
- grid.508163.90000 0004 7665 4668Department of Gastroenterology and Hepatology, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| | - Cui-Li Lin
- grid.508163.90000 0004 7665 4668Department of Gastroenterology and Hepatology, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| | - Fung-Joon Foo
- grid.508163.90000 0004 7665 4668Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, 110 Sengkang East Way, Singapore, 544886 Singapore ,grid.508163.90000 0004 7665 4668Endoscopy Centre, Division of Hyperacute Care, Sengkang General Hospital, Singapore, Singapore
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Guerrisi A, Falcone I, Valenti F, Rao M, Gallo E, Ungania S, Maccallini MT, Fanciulli M, Frascione P, Morrone A, Caterino M. Artificial Intelligence and Advanced Melanoma: Treatment Management Implications. Cells 2022; 11:cells11243965. [PMID: 36552729 PMCID: PMC9777238 DOI: 10.3390/cells11243965] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Artificial intelligence (AI), a field of research in which computers are applied to mimic humans, is continuously expanding and influencing many aspects of our lives. From electric cars to search motors, AI helps us manage our daily lives by simplifying functions and activities that would be more complex otherwise. Even in the medical field, and specifically in oncology, many studies in recent years have highlighted the possible helping role that AI could play in clinical and therapeutic patient management. In specific contexts, clinical decisions are supported by "intelligent" machines and the development of specific softwares that assist the specialist in the management of the oncology patient. Melanoma, a highly heterogeneous disease influenced by several genetic and environmental factors, to date is still difficult to manage clinically in its advanced stages. Therapies often fail, due to the establishment of intrinsic or secondary resistance, making clinical decisions complex. In this sense, although much work still needs to be conducted, numerous evidence shows that AI (through the processing of large available data) could positively influence the management of the patient with advanced melanoma, helping the clinician in the most favorable therapeutic choice and avoiding unnecessary treatments that are sure to fail. In this review, the most recent applications of AI in melanoma will be described, focusing especially on the possible finding of this field in the management of drug treatments.
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Affiliation(s)
- Antonino Guerrisi
- Radiology and Diagnostic Imaging Unit, Department of Clinical and Dermatological Research, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | - Italia Falcone
- SAFU, Department of Research, Advanced Diagnostics, and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence:
| | - Fabio Valenti
- UOC Oncological Translational Research, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Marco Rao
- Enea-FSN-TECFIS-APAM, C.R. Frascati, via Enrico Fermi, 45, 00146 Rome, Italy
| | - Enzo Gallo
- Pathology Unit, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Sara Ungania
- Medical Physics and Expert Systems Laboratory, Department of Research and Advanced Technologies, IRCCS-Regina Elena Institute, 00144 Rome, Italy
| | - Maria Teresa Maccallini
- Departement of Clinical and Molecular Medicine, Università La Sapienza di Roma, 00185 Rome, Italy
| | - Maurizio Fanciulli
- SAFU, Department of Research, Advanced Diagnostics, and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Pasquale Frascione
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, 00144 Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | - Mauro Caterino
- Radiology and Diagnostic Imaging Unit, Department of Clinical and Dermatological Research, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
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Chang YY, Li PC, Chang RF, Chang YY, Huang SP, Chen YY, Chang WY, Yen HH. Development and validation of a deep learning-based algorithm for colonoscopy quality assessment. Surg Endosc 2022; 36:6446-6455. [PMID: 35132449 DOI: 10.1007/s00464-021-08993-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/31/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Quality indicators should be assessed and monitored to improve colonoscopy quality in clinical practice. Endoscopists must enter relevant information in the endoscopy reporting system to facilitate data collection, which may be inaccurate. The current study aimed to develop a full deep learning-based algorithm to identify and analyze intra-procedural colonoscopy quality indicators based on endoscopy images obtained during the procedure. METHODS A deep learning system for classifying colonoscopy images for quality assurance purposes was developed and its performance was assessed with an independent dataset. The system was utilized to analyze captured images and results were compared with those of real-world reports. RESULTS In total, 10,417 images from the hospital endoscopy database and 3157 from Hyper-Kvasir open dataset were utilized to develop the quality assurance algorithm. The overall accuracy of the algorithm was 96.72% and that of the independent test dataset was 94.71%. Moreover, 761 real-world reports and colonoscopy images were analyzed. The accuracy of electronic reports about cecal intubation rate was 99.34% and that of the algorithm was 98.95%. The agreement rate for the assessment of polypectomy rates using the electronic reports and the algorithm was 0.87 (95% confidence interval 0.83-0.90). A good correlation was found between the withdrawal time calculated using the algorithm and that entered by the physician (correlation coefficient r = 0.959, p < 0.0001). CONCLUSION We proposed a novel deep learning-based algorithm that used colonoscopy images for quality assurance purposes. This model can be used to automatically assess intra-procedural colonoscopy quality indicators in clinical practice.
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Affiliation(s)
- Yuan-Yen Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Pai-Chi Li
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ruey-Feng Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
- Artificial Intelligence Development Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Yao Chang
- Department of Colorectal Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Siou-Ping Huang
- Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yang-Yuan Chen
- Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Yen Chang
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsu-Heng Yen
- Artificial Intelligence Development Center, Changhua Christian Hospital, Changhua, Taiwan.
- Department of Colorectal Surgery, Changhua Christian Hospital, Changhua, Taiwan.
- Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan.
- Department of Electrical Engineering, Chung Yuan University, Taoyuan, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
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Gong EJ, Bang CS, Lee JJ, Yang YJ, Baik GH. Impact of the Volume and Distribution of Training Datasets in the Development of Deep-Learning Models for the Diagnosis of Colorectal Polyps in Endoscopy Images. J Pers Med 2022; 12:jpm12091361. [PMID: 36143146 PMCID: PMC9505038 DOI: 10.3390/jpm12091361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/13/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Establishment of an artificial intelligence model in gastrointestinal endoscopy has no standardized dataset. The optimal volume or class distribution of training datasets has not been evaluated. An artificial intelligence model was previously created by the authors to classify endoscopic images of colorectal polyps into four categories, including advanced colorectal cancer, early cancers/high-grade dysplasia, tubular adenoma, and nonneoplasm. The aim of this study was to evaluate the impact of the volume and distribution of training dataset classes in the development of deep-learning models for colorectal polyp histopathology prediction from endoscopic images. Methods: The same 3828 endoscopic images that were used to create earlier models were used. An additional 6838 images were used to find the optimal volume and class distribution for a deep-learning model. Various amounts of data volume and class distributions were tried to establish deep-learning models. The training of deep-learning models uniformly used no-code platform Neuro-T. Accuracy was the primary outcome on four-class prediction. Results: The highest internal-test classification accuracy in the original dataset, doubled dataset, and tripled dataset was commonly shown by doubling the proportion of data for fewer categories (2:2:1:1 for advanced colorectal cancer: early cancers/high-grade dysplasia: tubular adenoma: non-neoplasm). Doubling the proportion of data for fewer categories in the original dataset showed the highest accuracy (86.4%, 95% confidence interval: 85.0–97.8%) compared to that of the doubled or tripled dataset. The total required number of images in this performance was only 2418 images. Gradient-weighted class activation mapping confirmed that the part that the deep-learning model pays attention to coincides with the part that the endoscopist pays attention to. Conclusion: As a result of a data-volume-dependent performance plateau in the classification model of colonoscopy, a dataset that has been doubled or tripled is not always beneficial to training. Deep-learning models would be more accurate if the proportion of fewer category lesions was increased.
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Affiliation(s)
- Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea
- Correspondence: ; Tel.: +82-33-240-5821; Fax: +82-33-241-8064
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Young Joo Yang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24253, Korea
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No-Code Platform-Based Deep-Learning Models for Prediction of Colorectal Polyp Histology from White-Light Endoscopy Images: Development and Performance Verification. J Pers Med 2022; 12:jpm12060963. [PMID: 35743748 PMCID: PMC9225479 DOI: 10.3390/jpm12060963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 12/17/2022] Open
Abstract
Background: The authors previously developed deep-learning models for the prediction of colorectal polyp histology (advanced colorectal cancer, early cancer/high-grade dysplasia, tubular adenoma with or without low-grade dysplasia, or non-neoplasm) from endoscopic images. While the model achieved 67.3% internal-test accuracy and 79.2% external-test accuracy, model development was labour-intensive and required specialised programming expertise. Moreover, the 240-image external-test dataset included only three advanced and eight early cancers, so it was difficult to generalise model performance. These limitations may be mitigated by deep-learning models developed using no-code platforms. Objective: To establish no-code platform-based deep-learning models for the prediction of colorectal polyp histology from white-light endoscopy images and compare their diagnostic performance with traditional models. Methods: The same 3828 endoscopic images used to establish previous models were used to establish new models based on no-code platforms Neuro-T, VLAD, and Create ML-Image Classifier. A prospective multicentre validation study was then conducted using 3818 novel images. The primary outcome was the accuracy of four-category prediction. Results: The model established using Neuro-T achieved the highest internal-test accuracy (75.3%, 95% confidence interval: 71.0–79.6%) and external-test accuracy (80.2%, 76.9–83.5%) but required the longest training time. In contrast, the model established using Create ML-Image Classifier required only 3 min for training and still achieved 72.7% (70.8–74.6%) external-test accuracy. Attention map analysis revealed that the imaging features used by the no-code deep-learning models were similar to those used by endoscopists during visual inspection. Conclusion: No-code deep-learning tools allow for the rapid development of models with high accuracy for predicting colorectal polyp histology.
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Yang CB, Kim SH, Lim YJ. Preparation of image databases for artificial intelligence algorithm development in gastrointestinal endoscopy. Clin Endosc 2022; 55:594-604. [PMID: 35636749 PMCID: PMC9539300 DOI: 10.5946/ce.2021.229] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/07/2022] [Indexed: 12/09/2022] Open
Abstract
Over the past decade, technological advances in deep learning have led to the introduction of artificial intelligence (AI) in medical imaging. The most commonly used structure in image recognition is the convolutional neural network, which mimics the action of the human visual cortex. The applications of AI in gastrointestinal endoscopy are diverse. Computer-aided diagnosis has achieved remarkable outcomes with recent improvements in machine-learning techniques and advances in computer performance. Despite some hurdles, the implementation of AI-assisted clinical practice is expected to aid endoscopists in real-time decision-making. In this summary, we reviewed state-of-the-art AI in the field of gastrointestinal endoscopy and offered a practical guide for building a learning image dataset for algorithm development.
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Affiliation(s)
- Chang Bong Yang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Sang Hoon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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12
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Fati SM, Senan EM, Azar AT. Hybrid and Deep Learning Approach for Early Diagnosis of Lower Gastrointestinal Diseases. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22114079. [PMID: 35684696 PMCID: PMC9185306 DOI: 10.3390/s22114079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 05/27/2023]
Abstract
Every year, nearly two million people die as a result of gastrointestinal (GI) disorders. Lower gastrointestinal tract tumors are one of the leading causes of death worldwide. Thus, early detection of the type of tumor is of great importance in the survival of patients. Additionally, removing benign tumors in their early stages has more risks than benefits. Video endoscopy technology is essential for imaging the GI tract and identifying disorders such as bleeding, ulcers, polyps, and malignant tumors. Videography generates 5000 frames, which require extensive analysis and take a long time to follow all frames. Thus, artificial intelligence techniques, which have a higher ability to diagnose and assist physicians in making accurate diagnostic decisions, solve these challenges. In this study, many multi-methodologies were developed, where the work was divided into four proposed systems; each system has more than one diagnostic method. The first proposed system utilizes artificial neural networks (ANN) and feed-forward neural networks (FFNN) algorithms based on extracting hybrid features by three algorithms: local binary pattern (LBP), gray level co-occurrence matrix (GLCM), and fuzzy color histogram (FCH) algorithms. The second proposed system uses pre-trained CNN models which are the GoogLeNet and AlexNet based on the extraction of deep feature maps and their classification with high accuracy. The third proposed method uses hybrid techniques consisting of two blocks: the first block of CNN models (GoogLeNet and AlexNet) to extract feature maps; the second block is the support vector machine (SVM) algorithm for classifying deep feature maps. The fourth proposed system uses ANN and FFNN based on the hybrid features between CNN models (GoogLeNet and AlexNet) and LBP, GLCM and FCH algorithms. All the proposed systems achieved superior results in diagnosing endoscopic images for the early detection of lower gastrointestinal diseases. All systems produced promising results; the FFNN classifier based on the hybrid features extracted by GoogLeNet, LBP, GLCM and FCH achieved an accuracy of 99.3%, precision of 99.2%, sensitivity of 99%, specificity of 100%, and AUC of 99.87%.
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Affiliation(s)
- Suliman Mohamed Fati
- College of Computer and Information Sciences, Prince Sultan University, Riyadh 11586, Saudi Arabia;
| | - Ebrahim Mohammed Senan
- Department of Computer Science & Information Technology, Dr. Babasaheb Ambedkar Marathwada University, Aurangabad 431004, India;
| | - Ahmad Taher Azar
- College of Computer and Information Sciences, Prince Sultan University, Riyadh 11586, Saudi Arabia;
- Faculty of Computers and Artificial Intelligence, Benha University, Benha 13518, Egypt
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Zippelius C, Alqahtani SA, Schedel J, Brookman-Amissah D, Muehlenberg K, Federle C, Salzberger A, Schorr W, Pech O. Diagnostic accuracy of a novel artificial intelligence system for adenoma detection in daily practice: a prospective nonrandomized comparative study. Endoscopy 2022; 54:465-472. [PMID: 34293812 DOI: 10.1055/a-1556-5984] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adenoma detection rate (ADR) varies significantly between endoscopists, with adenoma miss rates (AMRs) up to 26 %. Artificial intelligence (AI) systems may improve endoscopy quality and reduce the rate of interval cancer. We evaluated the efficacy of an AI system in real-time colonoscopy and its influence on AMR and ADR. METHODS This prospective, nonrandomized, comparative study analyzed patients undergoing diagnostic colonoscopy at a single endoscopy center in Germany from June to October 2020. Every patient was examined concurrently by an endoscopist and AI using two opposing screens. The AI system, overseen by a second observer, was not visible to the endoscopist. AMR was the primary outcome. Both methods were compared using McNemar test. RESULTS 150 patients were included (mean age 65 years [standard deviation 14]; 69 women). There was no significant or clinically relevant difference (P = 0.75) in AMR between the AI system (6/197, 3.0 %; 95 % confidence interval [CI] 1.1-6.5) and routine colonoscopy (4/197, 2.0 %; 95 %CI 0.6-5.1). The polyp miss rate of the AI system (14/311, 4.5 %; 95 %CI 2.5-7.4) was not significantly different (P = 0.72) from routine colonoscopy (17/311, 5.5 %; 95 %CI 3.2-8.6). There was no significant difference (P = 0.50) in ADR between routine colonoscopy (78/150, 52.0 %; 95 %CI 43.7-60.2) and the AI system (76/150, 50.7 %; 95 %CI 42.4-58.9). Routine colonoscopy detected adenomas in two patients that were missed by the AI system. CONCLUSION The AI system performance was comparable to that of experienced endoscopists during real-time colonoscopy with similar high ADR (> 50 %).
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Affiliation(s)
- Carolin Zippelius
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Saleh A Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Jörg Schedel
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Dominic Brookman-Amissah
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Klaus Muehlenberg
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Christoph Federle
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Andrea Salzberger
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Wolfgang Schorr
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.,Liver Transplant Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
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Abstract
The health system can reap significant benefits by adopting and implementing innovative measures, as was recently demonstrated and emphasized during the COVID-19 pandemic. Herein, we present our bird's eye view of gastroenterology's innovative technologies via utilizing a text-mining technique. We analyzed five research fields that comply with innovation: artificial intelligence (AI), virtual reality (VR), telemedicine, the microbiome, and advanced endoscopy. According to gastroenterology literature, the two most innovative fields were the microbiome and advanced endoscopy. Though artificial intelligence (AI), virtual reality (VR), and telemedicine trailed behind, the number of AI publications in gastroenterology has shown an exponential trend in the last couple of years. While VR and telemedicine are neglected compared to other fields, their implementation could improve physician and patient training, patient access to care, cost reduction, and patient outcomes.
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15
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Klang E, Soffer S, Tsur A, Shachar E, Lahat A. Innovation in Gastroenterology—Can We Do Better? Biomimetics (Basel) 2022; 7:biomimetics7010033. [PMID: 35323190 PMCID: PMC8945015 DOI: 10.3390/biomimetics7010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
The health system can reap significant benefits by adopting and implementing innovative measures, as was recently demonstrated and emphasized during the COVID-19 pandemic. Herein, we present our bird’s eye view of gastroenterology’s innovative technologies via utilizing a text-mining technique. We analyzed five research fields that comply with innovation: artificial intelligence (AI), virtual reality (VR), telemedicine, the microbiome, and advanced endoscopy. According to gastroenterology literature, the two most innovative fields were the microbiome and advanced endoscopy. Though artificial intelligence (AI), virtual reality (VR), and telemedicine trailed behind, the number of AI publications in gastroenterology has shown an exponential trend in the last couple of years. While VR and telemedicine are neglected compared to other fields, their implementation could improve physician and patient training, patient access to care, cost reduction, and patient outcomes.
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Affiliation(s)
- Eyal Klang
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel, and Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel;
- Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel, and Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel
- DeepVision Lab, Sheba Medical Center, Tel Aviv 6997801, Israel
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Mount Sinai Health System, New York, NY 10016, USA
| | - Shelly Soffer
- DeepVision Lab, Sheba Medical Center, Tel Aviv 6997801, Israel
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel, and Ben-Gurion University of the Negev, Be’er Sheva 8410501, Israel
- Samson Assuta Ashdod University Hospital, Ha-Refu’a St 7, Ashdod 7747629, Israel
- Correspondence: ; Tel.: +973-8-300-4100; Fax: +972-3-5357315
| | - Abraham Tsur
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel, and Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Eyal Shachar
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, and Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel; (E.S.); (A.L.)
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, and Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel; (E.S.); (A.L.)
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Muguruma N, Takayama T. Artificial Intelligence-Based Colorectal Polyp Histology Prediction: High Accuracy in Larger Polyps. Clin Endosc 2022; 55:45-46. [PMID: 34974677 PMCID: PMC8831397 DOI: 10.5946/ce.2021.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Naoki Muguruma
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Kim W, Lee B, Yoo A, Kim S, Joo M, Park JJ. Predictors of Positive Video Capsule Endoscopy Findings for Chronic Unexplained Abdominal Pain: Single-Center Retrospective Study and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11112123. [PMID: 34829470 PMCID: PMC8617728 DOI: 10.3390/diagnostics11112123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/13/2021] [Accepted: 11/14/2021] [Indexed: 11/26/2022] Open
Abstract
Video capsule endoscopy (VCE) is an effective diagnostic modality for detecting small bowel lesions. However, the value of VCE for patients with chronic recurrent abdominal pain (CAP) of unknown etiology remains obscure. We retrospectively analyzed factors that could predict enteropathy based on the medical records of 65 patients with unexplained chronic recurrent abdominal pain (CAP) who were assessed using VCE between 2001 and 2021. We also conducted a systematic review and meta-analysis of the literature to validate our results. The positive findings of 27 (41.5%) of the 65 patients were mostly ulcerative lesions including stricture (n = 14, 60.9%) and erosion (n = 8, 29.7%). Multivariate analysis identified elevated ESR (OR, 1.06, 95% CI, 1.02–1.1, p = 0.004) as a significant risk factor for enteropathy predicted by VCE. Three eligible studies in the meta-analysis included 523 patients with CAP. Elevated C-reactive protein (CRP) (OR, 14.09; 95% CI, 2.81–70.60; p = 0.001) and erythrocyte sedimentation rate (ESR) (OR, 14.45; 95% CI, 0.92–227.33; p = 0.06) indicated VCE-positive findings in patients with unexplained abdominal pain. Elevated levels of the inflammatory markers ESR and CRP can thus predict positive VCE findings in patients with CAP.
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Affiliation(s)
| | - Beomjae Lee
- Correspondence: ; Tel.: +82-2-2626-3004; Fax: +82-2-853-1943
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Cortegoso Valdivia P, Elosua A, Houdeville C, Pennazio M, Fernández-Urién I, Dray X, Toth E, Eliakim R, Koulaouzidis A. Clinical feasibility of panintestinal (or panenteric) capsule endoscopy: a systematic review. Eur J Gastroenterol Hepatol 2021; 33:949-955. [PMID: 34034282 DOI: 10.1097/meg.0000000000002200] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In recent years, panintestinal capsule endoscopy (PCE) with double-headed capsules has been used to perform complete, single-sitting exploration of both small bowel and colon in different clinical conditions. Double-headed capsules for colonic examination (CCE) have been exploited first in this setting, followed by newer generations of capsules (i.e. PillCam Crohn, PCC) specifically engineered for this purpose. The aim of this study was to evaluate the feasibility of PCE in the form of a systematic review. We performed a comprehensive literature search to identify papers in which CE was specifically used for a PCE of the gastrointestinal tract. Data on CE, bowel preparation regimen, rate of cleanliness and completeness, and data on transit times were analyzed. The primary outcome was to assess the feasibility of a whole-gut exploration with CE. Sixteen (n = 16) studies including 915 CE procedures with CCE1 (n = 134), CCE2 (n = 357) and PCC (n = 424) were included. 13/16 studies were performed in the setting of Crohn's disease. Cleanliness and completeness rates were acceptable in all studies, ranging from 63.9% and 68.6% to 100%, respectively. In conclusion, PCE is a feasible technique, although further structured studies are needed to explore its full potential.
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Affiliation(s)
- Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Alfonso Elosua
- Gastroenterology Unit, Hospital Garcia Orcoyen, Estella, Spain
| | - Charles Houdeville
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | - Marco Pennazio
- University Division of Gastroenterology, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Xavier Dray
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Rami Eliakim
- Department of Gastroenterology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
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