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Ahmed W, Joshi D, Huggett MT, Everett SM, James M, Menon S, Oppong KW, On W, Paranandi B, Trivedi P, Webster G, Hegade VS. Update on the optimisation of endoscopic retrograde cholangiography (ERC) in patients with primary sclerosing cholangitis. Frontline Gastroenterol 2024; 15:74-83. [PMID: 38487565 PMCID: PMC10935540 DOI: 10.1136/flgastro-2023-102491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/28/2023] [Indexed: 03/17/2024] Open
Affiliation(s)
- Wafaa Ahmed
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Deepak Joshi
- Gastroenterology, King's College Hospital Liver Unit, London, UK
| | - Matthew T Huggett
- Gastroenterology, St James's University Hospital, The Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - Simon M Everett
- Gastroenterology, St James's University Hospital NHS Trust, Leeds, UK
| | - Martin James
- Gastroenterology, Nottingham University, Nottingham, UK
| | - Shyam Menon
- Department of Hepatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Wei On
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Bharat Paranandi
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Palak Trivedi
- National Institute for Health Research, Centre for Liver Research, University Hospitals Birmingham, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - George Webster
- Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, UK
| | - Vinod S Hegade
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Buerlein RCD, Podboy AJ, Strand DS. Individualized Approach to the Management of Hilar Cholangiocarcinoma: How We Do It. Am J Gastroenterol 2023; 118:2101-2105. [PMID: 37126854 DOI: 10.14309/ajg.0000000000002311] [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: 10/12/2022] [Accepted: 04/27/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Ross C D Buerlein
- Section of Interventional Endoscopy, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
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Saraiva MM, Ribeiro T, González-Haba M, Agudo Castillo B, Ferreira JPS, Vilas Boas F, Afonso J, Mendes F, Martins M, Cardoso P, Pereira P, Macedo G. Deep Learning for Automatic Diagnosis and Morphologic Characterization of Malignant Biliary Strictures Using Digital Cholangioscopy: A Multicentric Study. Cancers (Basel) 2023; 15:4827. [PMID: 37835521 PMCID: PMC10571941 DOI: 10.3390/cancers15194827] [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: 08/03/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Digital single-operator cholangioscopy (D-SOC) has enhanced the ability to diagnose indeterminate biliary strictures (BSs). Pilot studies using artificial intelligence (AI) models in D-SOC demonstrated promising results. Our group aimed to develop a convolutional neural network (CNN) for the identification and morphological characterization of malignant BSs in D-SOC. A total of 84,994 images from 129 D-SOC exams in two centers (Portugal and Spain) were used for developing the CNN. Each image was categorized as either a normal/benign finding or as malignant lesion (the latter dependent on histopathological results). Additionally, the CNN was evaluated for the detection of morphologic features, including tumor vessels and papillary projections. The complete dataset was divided into training and validation datasets. The model was evaluated through its sensitivity, specificity, positive and negative predictive values, accuracy and area under the receiver-operating characteristic and precision-recall curves (AUROC and AUPRC, respectively). The model achieved a 82.9% overall accuracy, 83.5% sensitivity and 82.4% specificity, with an AUROC and AUPRC of 0.92 and 0.93, respectively. The developed CNN successfully distinguished benign findings from malignant BSs. The development and application of AI tools to D-SOC has the potential to significantly augment the diagnostic yield of this exam for identifying malignant strictures.
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Affiliation(s)
- Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Mariano González-Haba
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, 28220 Majadahonda, Madrid, Spain
| | - Belén Agudo Castillo
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, 28220 Majadahonda, Madrid, Spain
| | - João P. S. Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- DigestAID—Digestive Artificial Intelligence Development, Rua Alfredo Allen n.º 455/461, 4200-135 Porto, Portugal
| | - Filipe Vilas Boas
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Francisco Mendes
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Miguel Martins
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Pedro Cardoso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Pedro Pereira
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
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Ricaurte-Ciro J, Baquerizo-Burgos J, Carvajal-Gutierrez J, Mendez JC, Robles-Medranda C. Usefulness of artificial intelligence-assisted digital single-operator cholangioscopy as a second-opinion consultation tool during interhospital assessment of an indeterminate biliary stricture: a case report. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:364-366. [PMID: 37719954 PMCID: PMC10500173 DOI: 10.1016/j.vgie.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Video 1Application of a novel digital single-operator cholangioscopy-based convolutional neuronal network to detect neoplastic lesions as a second-opinion consultation tool between 2 hospitals and biopsy sampling.
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Robles-Medranda C, Baquerizo-Burgos J, Alcivar-Vasquez J, Kahaleh M, Raijman I, Kunda R, Puga-Tejada M, Egas-Izquierdo M, Arevalo-Mora M, Mendez JC, Tyberg A, Sarkar A, Shahid H, del Valle-Zavala R, Rodriguez J, Merfea RC, Barreto-Perez J, Saldaña-Pazmiño G, Calle-Loffredo D, Alvarado H, Lukashok HP. Artificial intelligence for diagnosing neoplasia on digital cholangioscopy: development and multicenter validation of a convolutional neural network model. Endoscopy 2023; 55:719-727. [PMID: 36781156 PMCID: PMC10374349 DOI: 10.1055/a-2034-3803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 02/13/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND We aimed to develop a convolutional neural network (CNN) model for detecting neoplastic lesions during real-time digital single-operator cholangioscopy (DSOC) and to clinically validate the model through comparisons with DSOC expert and nonexpert endoscopists. METHODS In this two-stage study, we first developed and validated CNN1. Then, we performed a multicenter diagnostic trial to compare four DSOC experts and nonexperts against an improved model (CNN2). Lesions were classified into neoplastic and non-neoplastic in accordance with Carlos Robles-Medranda (CRM) and Mendoza disaggregated criteria. The final diagnosis of neoplasia was based on histopathology and 12-month follow-up outcomes. RESULTS In stage I, CNN2 achieved a mean average precision of 0.88, an intersection over the union value of 83.24 %, and a total loss of 0.0975. For clinical validation, a total of 170 videos from newly included patients were analyzed with the CNN2. Half of cases (50 %) had neoplastic lesions. This model achieved significant accuracy values for neoplastic diagnosis, with a 90.5 % sensitivity, 68.2 % specificity, and 74.0 % and 87.8 % positive and negative predictive values, respectively. The CNN2 model outperformed nonexpert #2 (area under the receiver operating characteristic curve [AUC]-CRM 0.657 vs. AUC-CNN2 0.794, P < 0.05; AUC-Mendoza 0.582 vs. AUC-CNN2 0.794, P < 0.05), nonexpert #4 (AUC-CRM 0.683 vs. AUC-CNN2 0.791, P < 0.05), and expert #4 (AUC-CRM 0.755 vs. AUC-CNN2 0.848, P < 0.05; AUC-Mendoza 0.753 vs. AUC-CNN2 0.848, P < 0.05). CONCLUSIONS The proposed CNN model distinguished neoplastic bile duct lesions with good accuracy and outperformed two nonexpert and one expert endoscopist.
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Affiliation(s)
- Carlos Robles-Medranda
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Juan Alcivar-Vasquez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Isaac Raijman
- Houston Methodist Hospital, Houston, Texas, United States
- Baylor Saint Luke’s Medical Center, Houston, Texas, United States
| | - Rastislav Kunda
- Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel (UZB)/Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Miguel Puga-Tejada
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Maria Egas-Izquierdo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Martha Arevalo-Mora
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Juan C. Mendez
- mdconsgroup, Artificial Intelligence Department, Guayaquil, Ecuador
| | - Amy Tyberg
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Haroon Shahid
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Raquel del Valle-Zavala
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jorge Rodriguez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Ruxandra C. Merfea
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jonathan Barreto-Perez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | | | - Daniel Calle-Loffredo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Haydee Alvarado
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Hannah P. Lukashok
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
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Cholangioscopy for biliary diseases. Curr Opin Gastroenterol 2023; 39:67-74. [PMID: 36821453 DOI: 10.1097/mog.0000000000000907] [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] [Indexed: 02/24/2023]
Abstract
PURPOSE OF REVIEW Cholangioscopy is a mini-invasive endoscopic procedure, which consists in a direct intraductal visualization of the biliary tract. The purpose of this review is to summarize the technique, the clinical applications, as well as future perspectives of cholangioscopy. RECENT FINDINGS Numerous technologic advances during the last decades have allowed for an improved utility and functionality, leading to a broader use of this procedure, for diagnostic or therapeutic purposes, in the setting of biliary diseases. Novel tools and emerging indications have been developed and more are yet to come. SUMMARY Cholangioscopy can be performed by peroral, percutaneous transhepatic or intra-operative transcystic or transcholedochal access. Clinical applications of cholangioscopy are multiple, ranging from visual impression and optical guided biopsies of indeterminate biliary strictures to the management of difficult stones , guidance before biliary stenting and retrieval of migrated ductal stents. Multiple devices such as lithotripsy probes, biopsy forceps, snares and baskets have been developed to help achieve these procedures successfully.Cholangioscopy has improved the way biliary diseases can be visualized and treated. New technology, accessories, and applications are expected in the future.
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Saraiva MM, Ribeiro T, Afonso J, Boas FV, Ferreira JPS, Pereira P, Macedo G. Response. Gastrointest Endosc 2022; 96:1093-1094. [PMID: 36404093 DOI: 10.1016/j.gie.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University HospitalPorto, Portugal; WGO Gastroenterology and Hepatology Training CenterPorto, Portugal; Faculty of Medicine, University of PortoPorto, Portugal
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University HospitalPorto, Portugal; WGO Gastroenterology and Hepatology Training CenterPorto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University HospitalPorto, Portugal; WGO Gastroenterology and Hepatology Training CenterPorto, Portugal
| | - Filipe Vilas Boas
- Department of Gastroenterology, São João University HospitalPorto, Portugal; WGO Gastroenterology and Hepatology Training CenterPorto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - João P S Ferreira
- Department of Mechanical Engineering, Faculty of Engineering of the University of PortoPorto, Portugal; Institute of Science and Innovation in Mechanical and Industrial EngineeringPorto, Portugal
| | - Pedro Pereira
- Department of Gastroenterology, São João University HospitalPorto, Portugal; WGO Gastroenterology and Hepatology Training CenterPorto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University HospitalPorto, Portugal; WGO Gastroenterology and Hepatology Training CenterPorto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
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Brenner AR, Laoveeravat P, Carey PJ, Joiner D, Mardini SH, Jovani M. Artificial intelligence using advanced imaging techniques and cholangiocarcinoma: Recent advances and future direction. Artif Intell Gastroenterol 2022; 3:88-95. [DOI: 10.35712/aig.v3.i3.88] [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: 03/07/2022] [Revised: 04/16/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023] Open
Abstract
While cholangiocarcinoma represents only about 3% of all gastrointestinal tumors, it has a dismal survival rate, usually because it is diagnosed at a late stage. The utilization of Artificial Intelligence (AI) in medicine in general, and in gastroenterology has made gigantic steps. However, the application of AI for biliary disease, in particular for cholangiocarcinoma, has been sub-optimal. The use of AI in combination with clinical data, cross-sectional imaging (computed tomography, magnetic resonance imaging) and endoscopy (endoscopic ultrasound and cholangioscopy) has the potential to significantly improve early diagnosis and the choice of optimal therapeutic options, leading to a transformation in the prognosis of this feared disease. In this review we summarize the current knowledge on the use of AI for the diagnosis and management of cholangiocarcinoma and point to future directions in the field.
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Affiliation(s)
- Aaron R Brenner
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40536, United States
| | - Passisd Laoveeravat
- Division of Digestive Diseases and Nutrition, University of Kentucky College of Medicine, Lexington, KY 40536, United States
| | - Patrick J Carey
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40536, United States
| | - Danielle Joiner
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40536, United States
| | - Samuel H Mardini
- Division of Digestive Diseases and Nutrition, University of Kentucky College of Medicine, Lexington, KENTUCKY 40536, United States
| | - Manol Jovani
- Digestive Diseases and Nutrition, University of Kentucky Albert B. Chandler Hospital, Lexington, KY 40536, United States
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