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Ebigbo A, Mendel R, Rückert T, Schuster L, Probst A, Manzeneder J, Prinz F, Mende M, Steinbrück I, Faiss S, Rauber D, de Souza LA, Papa JP, Deprez PH, Oyama T, Takahashi A, Seewald S, Sharma P, Byrne MF, Palm C, Messmann H. Endoscopic prediction of submucosal invasion in Barrett's cancer with the use of artificial intelligence: a pilot study. Endoscopy 2021; 53:878-883. [PMID: 33197942 DOI: 10.1055/a-1311-8570] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The accurate differentiation between T1a and T1b Barrett's-related cancer has both therapeutic and prognostic implications but is challenging even for experienced physicians. We trained an artificial intelligence (AI) system on the basis of deep artificial neural networks (deep learning) to differentiate between T1a and T1b Barrett's cancer on white-light images. METHODS Endoscopic images from three tertiary care centers in Germany were collected retrospectively. A deep learning system was trained and tested using the principles of cross validation. A total of 230 white-light endoscopic images (108 T1a and 122 T1b) were evaluated using the AI system. For comparison, the images were also classified by experts specialized in endoscopic diagnosis and treatment of Barrett's cancer. RESULTS The sensitivity, specificity, F1 score, and accuracy of the AI system in the differentiation between T1a and T1b cancer lesions was 0.77, 0.64, 0.74, and 0.71, respectively. There was no statistically significant difference between the performance of the AI system and that of experts, who showed sensitivity, specificity, F1, and accuracy of 0.63, 0.78, 0.67, and 0.70, respectively. CONCLUSION This pilot study demonstrates the first multicenter application of an AI-based system in the prediction of submucosal invasion in endoscopic images of Barrett's cancer. AI scored equally to international experts in the field, but more work is necessary to improve the system and apply it to video sequences and real-life settings. Nevertheless, the correct prediction of submucosal invasion in Barrett's cancer remains challenging for both experts and AI.
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Affiliation(s)
- Alanna Ebigbo
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany.,Regensburg Center of Health Sciences and Technology (RCHST), OTH Regensburg, Regensburg, Germany
| | - Tobias Rückert
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany
| | - Laurin Schuster
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany
| | - Andreas Probst
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg Germany
| | | | - Friederike Prinz
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg Germany
| | - Matthias Mende
- Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Ingo Steinbrück
- Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Siegbert Faiss
- Gastroenterology, Sana Klinikum Lichtenberg, Berlin, Germany
| | - David Rauber
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany.,Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
| | - Luis A de Souza
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany.,Department of Computing, São Paulo State University, São Paulo, Brazil
| | - João P Papa
- Department of Computing, São Paulo State University, São Paulo, Brazil
| | - Pierre H Deprez
- Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tsuneo Oyama
- Saku Central Hospital Advanced Care Center, Nagano, Japan
| | | | | | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, United States
| | - Michael F Byrne
- Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg Germany.,Regensburg Center of Health Sciences and Technology (RCHST), OTH Regensburg, Regensburg, Germany.,Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
| | - Helmut Messmann
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg Germany
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Roemmele C, Manzeneder J, Messmann H, Ebigbo A. Impact of the COVID-19 outbreak on endoscopy training in a tertiary care centre in Germany. Frontline Gastroenterol 2020; 11:454-457. [PMID: 33093937 PMCID: PMC7569514 DOI: 10.1136/flgastro-2020-101504] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The COVID-19 crisis has impacted on all aspects of health care including medical education and training. We describe the disruption of endoscopy training in a tertiary care center in Germany. DESIGN/METHOD The reorganization of a high-volume endoscopy unit during the German COVID-19 outbreak is described with special focus on endoscopy trainees. Changes in case volume of gastroenterology fellows were evaluated and compared to a year prior to the outbreak. RESULTS Reallocation of resources led to the transfer of gastroenterology fellows to intensive care and infectious disease units. Case volume of fellows declined between January and April 2020 by up to 63%. When compared with data from the year prior to the outbreak, endoscopy performed by fellows reduced by up to 56%. Educational meetings and skill evaluation were cancelled indefinitely. CONCLUSION The COVID-19 outbreak has had a negative impact on endoscopy training of gastroenterology fellows in a high-volume center in Germany. This must be taken into consideration when planning "return-strategies" after the pandemic.
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Affiliation(s)
- Christoph Roemmele
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | - Johannes Manzeneder
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
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Ebigbo A, Mendel R, Probst A, Manzeneder J, Prinz F, de Souza Jr. LA, Papa J, Palm C, Messmann H. Real-time use of artificial intelligence in the evaluation of cancer in Barrett's oesophagus. Gut 2020; 69:615-616. [PMID: 31541004 PMCID: PMC7063447 DOI: 10.1136/gutjnl-2019-319460] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/30/2019] [Accepted: 09/08/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany,Regensburg Center of Health Sciences and Technology, OTH Regensburg, Regensburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Johannes Manzeneder
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Friederike Prinz
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Luis A de Souza Jr.
- Department of Computing, Federal University of São Carlos, São Carlos, Brazil
| | - Joao Papa
- Department of Computing, São Paulo State University, Bauru, Brazil
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany .,Regensburg Center of Health Sciences and Technology, OTH Regensburg, Regensburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
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Ebigbo A, Palm C, Probst A, Mendel R, Manzeneder J, Prinz F, de Souza LA, Papa JP, Siersema P, Messmann H. A technical review of artificial intelligence as applied to gastrointestinal endoscopy: clarifying the terminology. Endosc Int Open 2019; 7:E1616-E1623. [PMID: 31788542 PMCID: PMC6882682 DOI: 10.1055/a-1010-5705] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background and aim The growing number of publications on the application of artificial intelligence (AI) in medicine underlines the enormous importance and potential of this emerging field of research. In gastrointestinal endoscopy, AI has been applied to all segments of the gastrointestinal tract most importantly in the detection and characterization of colorectal polyps. However, AI research has been published also in the stomach and esophagus for both neoplastic and non-neoplastic disorders. The various technical as well as medical aspects of AI, however, remain confusing especially for non-expert physicians. This physician-engineer co-authored review explains the basic technical aspects of AI and provides a comprehensive overview of recent publications on AI in gastrointestinal endoscopy. Finally, a basic insight is offered into understanding publications on AI in gastrointestinal endoscopy.
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Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg) – Germany,Regensburg Center of Health Sciences and Technology, OTH Regensburg – Germany
| | - Andreas Probst
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg) – Germany,Regensburg Center of Health Sciences and Technology, OTH Regensburg – Germany
| | | | - Friederike Prinz
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Luis A. de Souza
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg) – Germany,Department of Computing, Federal University of São Carlos – Brazil
| | - João P. Papa
- Department of Computing, São Paulo State University – Brazil
| | - Peter Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
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Ebigbo A, Mendel R, Probst A, Manzeneder J, de Souza Jr LA, Papa JP, Palm C, Messmann H. Computer-aided diagnosis using deep learning in the evaluation of early oesophageal adenocarcinoma. Gut 2019; 68:1143-1145. [PMID: 30510110 PMCID: PMC6582741 DOI: 10.1136/gutjnl-2018-317573] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/22/2018] [Accepted: 11/14/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Alanna Ebigbo
- III Medizinische Klinik, Klinikum Augsburg, Augsburg, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg)-Germany, Regensburg, Germany
| | - Andreas Probst
- III Medizinische Klinik, Klinikum Augsburg, Augsburg, Germany
| | | | - Luis Antonio de Souza Jr
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg)-Germany, Regensburg, Germany,Department of Computing, São Paulo State University, São Paulo, Brazil
| | - João P Papa
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg)-Germany, Regensburg, Germany,Department of Computing, São Paulo State University, São Paulo, Brazil
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg)-Germany, Regensburg, Germany,Regensburg Center of Health Sciences and Technology (RCHST), OTH Regensburg-Germany, Regensburg, Germany
| | - Helmut Messmann
- III Medizinische Klinik, Klinikum Augsburg, Augsburg, Germany
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