1
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Sebastian S, Dhar A, Baddeley R, Donnelly L, Haddock R, Arasaradnam R, Coulter A, Disney BR, Griffiths H, Healey C, Hillson R, Steinbach I, Marshall S, Rajendran A, Rochford A, Thomas-Gibson S, Siddhi S, Stableforth W, Wesley E, Brett B, Morris AJ, Douds A, Coleman MG, Veitch AM, Hayee B. Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy. Gut 2023; 72:12-26. [PMID: 36229172 PMCID: PMC9763195 DOI: 10.1136/gutjnl-2022-328460] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/08/2022]
Abstract
GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.
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Affiliation(s)
- Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, East Riding of Yorkshire, UK .,Clinical Sciences Centre, Hull York Medical School, Hull, UK
| | - Anjan Dhar
- Department of Gastroenterology, Darlington Memorial Hospital, Darlington, UK,School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Robin Baddeley
- Institute for Therapeutic Endoscopy, King's College Hospital, London, UK,Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Leigh Donnelly
- Department of Gastroenterology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Rosemary Haddock
- Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee, UK
| | - Ramesh Arasaradnam
- Applied Biological and Experimental Sciences, Coventry University, Coventry, UK,Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Archibald Coulter
- Department of Gastroenterology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Benjamin Robert Disney
- Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Helen Griffiths
- Department of Gastroenterology, Brecon War Memorial Hospital, Brecon, UK
| | - Christopher Healey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, UK
| | | | | | - Sarah Marshall
- Bowel Cancer Screening & Endoscopy, London North West University Healthcare NHS Trust, Harrow, UK,Joint Advisory Group on GI Endoscopy, London, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Andrew Rochford
- Department of Gastroenterology, Royal Free Hospitals, London, UK
| | - Siwan Thomas-Gibson
- Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Sandeep Siddhi
- Department of Gastroenterology, NHS Grampian, Aberdeen, UK
| | - William Stableforth
- Departments of Gastroenterology & Endoscopy, Royal Cornwall Hospital, Truro, UK
| | - Emma Wesley
- Departments of Gastroenterology & Endoscopy, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Bernard Brett
- Department of Gastroenterology, Norfolk and Norwich Hospitals NHS Trust, Norwich, UK
| | | | - Andrew Douds
- Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Mark Giles Coleman
- Joint Advisory Group on GI Endoscopy, London, UK,Department of Colorectal Surgery, Plymouth University Hospitals Trust, Plymouth, UK
| | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Bu'Hussain Hayee
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
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2
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Hussein M, González‐Bueno Puyal J, Lines D, Sehgal V, Toth D, Ahmad OF, Kader R, Everson M, Lipman G, Fernandez‐Sordo JO, Ragunath K, Esteban JM, Bisschops R, Banks M, Haefner M, Mountney P, Stoyanov D, Lovat LB, Haidry R. A new artificial intelligence system successfully detects and localises early neoplasia in Barrett's esophagus by using convolutional neural networks. United European Gastroenterol J 2022; 10:528-537. [PMID: 35521666 PMCID: PMC9278593 DOI: 10.1002/ueg2.12233] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/31/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Seattle protocol biopsies for Barrett's Esophagus (BE) surveillance are labour intensive with low compliance. Dysplasia detection rates vary, leading to missed lesions. This can potentially be offset with computer aided detection. We have developed convolutional neural networks (CNNs) to identify areas of dysplasia and where to target biopsy. METHODS 119 Videos were collected in high-definition white light and optical chromoendoscopy with i-scan (Pentax Hoya, Japan) imaging in patients with dysplastic and non-dysplastic BE (NDBE). We trained an indirectly supervised CNN to classify images as dysplastic/non-dysplastic using whole video annotations to minimise selection bias and maximise accuracy. The CNN was trained using 148,936 video frames (31 dysplastic patients, 31 NDBE, two normal esophagus), validated on 25,161 images from 11 patient videos and tested on 264 iscan-1 images from 28 dysplastic and 16 NDBE patients which included expert delineations. To localise targeted biopsies/delineations, a second directly supervised CNN was generated based on expert delineations of 94 dysplastic images from 30 patients. This was tested on 86 i-scan one images from 28 dysplastic patients. FINDINGS The indirectly supervised CNN achieved a per image sensitivity in the test set of 91%, specificity 79%, area under receiver operator curve of 93% to detect dysplasia. Per-lesion sensitivity was 100%. Mean assessment speed was 48 frames per second (fps). 97% of targeted biopsy predictions matched expert and histological assessment at 56 fps. The artificial intelligence system performed better than six endoscopists. INTERPRETATION Our CNNs classify and localise dysplastic Barrett's Esophagus potentially supporting endoscopists during surveillance.
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Affiliation(s)
- Mohamed Hussein
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
- Department of GastroenterologyUniversity College London HospitalLondonUK
| | - Juana González‐Bueno Puyal
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
- Odin VisionLondonUK
| | | | - Vinay Sehgal
- Department of GastroenterologyUniversity College London HospitalLondonUK
| | | | - Omer F. Ahmad
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
- Department of GastroenterologyUniversity College London HospitalLondonUK
| | - Rawen Kader
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
| | - Martin Everson
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | - Gideon Lipman
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | | | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research CentreNottinghamUK
| | | | | | - Matthew Banks
- Department of GastroenterologyUniversity College London HospitalLondonUK
| | | | | | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
| | - Laurence B. Lovat
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
- Department of GastroenterologyUniversity College London HospitalLondonUK
| | - Rehan Haidry
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS)University College LondonLondonUK
- Department of GastroenterologyUniversity College London HospitalLondonUK
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3
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Abstract
Artificial intelligence (AI) is rapidly developing in various medical fields, and there is an increase in research performed in the field of gastrointestinal (GI) endoscopy. In particular, the advent of convolutional neural network, which is a class of deep learning method, has the potential to revolutionize the field of GI endoscopy, including esophagogastroduodenoscopy (EGD), capsule endoscopy (CE), and colonoscopy. A total of 149 original articles pertaining to AI (27 articles in esophagus, 30 articles in stomach, 29 articles in CE, and 63 articles in colon) were identified in this review. The main focuses of AI in EGD are cancer detection, identifying the depth of cancer invasion, prediction of pathological diagnosis, and prediction of Helicobacter pylori infection. In the field of CE, automated detection of bleeding sites, ulcers, tumors, and various small bowel diseases is being investigated. AI in colonoscopy has advanced with several patient-based prospective studies being conducted on the automated detection and classification of colon polyps. Furthermore, research on inflammatory bowel disease has also been recently reported. Most studies of AI in the field of GI endoscopy are still in the preclinical stages because of the retrospective design using still images. Video-based prospective studies are needed to advance the field. However, AI will continue to develop and be used in daily clinical practice in the near future. In this review, we have highlighted the published literature along with providing current status and insights into the future of AI in GI endoscopy.
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Affiliation(s)
- Yutaka Okagawa
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Gastroenterology, Tonan Hospital, Sapporo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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4
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Ratcliffe E, Britton J, Hamdy S, McLaughlin J, Ang Y. Developing patient-orientated Barrett's oesophagus services: the role of dedicated services. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000829. [PMID: 35193888 PMCID: PMC8867250 DOI: 10.1136/bmjgast-2021-000829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/09/2022] [Indexed: 11/03/2022] Open
Abstract
Introduction Barrett’s oesophagus (BO) is common and is a precursor to oesophageal adenocarcinoma with a 0.33% per annum risk of progression. Surveillance and follow-up services for BO have been shown to be lacking, with studies showing inadequate adherence to guidelines and patients reporting a need for greater disease-specific knowledge. This review explores the emerging role of dedicated services for patients with BO. Methods A literature search of PubMed, MEDLINE, Embase, Emcare, HMIC, BNI, CiNAHL, AMED and PsycINFO in regard to dedicated BO care pathways was undertaken. Results Prospective multicentre and randomised trials were lacking. Published cohort data are encouraging with improvements in guideline adherence with dedicated services, with one published study showing significant improvements in dysplasia detection rates. Accuracy of allocation to surveillance endoscopy has been shown to hold cost savings, and a study of a dedicated clinic showed increased discharges from unnecessary surveillance. Training modalities for BO surveillance and dysplasia detection exist, which could be used to educate a BO workforce. Qualitative and quantitative studies have shown patients report high levels of cancer worry and poor disease-specific knowledge, but few studies have explored follow-up care models despite being a patient and clinician priority for research. Conclusions Cost–benefit analysis for dedicated services, considering both financial and environmental impacts, and more robust clinical data must be obtained to support this model of care in the wider health service. Greater understanding is needed of the root causes for poor guideline adherence, and disease-specific models of care should be designed around clinical and patient-reported outcomes to address the unmet needs of patients with BO.
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Affiliation(s)
- Elizabeth Ratcliffe
- Gastroenterology, Wrightington Wigan and Leigh NHS Foundation Trust, Leigh, UK .,School of Medical Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - James Britton
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Shaheen Hamdy
- School of Medical Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK.,Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - John McLaughlin
- School of Medical Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK.,Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Yeng Ang
- School of Medical Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK.,Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
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5
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McGoran JJ, Ragunath K. Endoscopic management of Barrett's esophagus: Western perspective of current status and future prospects. Dig Endosc 2021; 33:720-729. [PMID: 32790886 DOI: 10.1111/den.13812] [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: 01/27/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Abstract
Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma and current practice is to establish endoscopic surveillance once diagnosed, in order to identify early dysplasia and neoplasia that has the potential to undergo endoscopic eradication therapy (EET). Before embarking upon EET the clinical team has a duty to consider all viable options and come to a plan based on recent evidence. The therapeutic approach varies greatly but largely adheres to the mantra of 'Detect-Resect-Ablate', in which high-quality endoscopy identifies BE associated pathology, associated lesions (if present) undergo safe endoscopic resection and remaining intestinal metaplasia in the esophagus is ablated to prevent recurrence of dysplasia. In this review, current practice, pitfalls, complications, and the future perspectives on practice in this field are discussed. The Western perspective is focused on here, with an outline of the differences in clinical practice with Asian nations and attempts to bridge these differences.
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Affiliation(s)
- John J McGoran
- Department of Digestive Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Krish Ragunath
- Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, WA, Australia.,Curtin University Medical School, Perth, WA, Australia
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6
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Bang CS. [Deep Learning in Upper Gastrointestinal Disorders: Status and Future Perspectives]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 75:120-131. [PMID: 32209800 DOI: 10.4166/kjg.2020.75.3.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 12/18/2022]
Abstract
Artificial intelligence using deep learning has been applied to gastrointestinal disorders for the detection, classification, and delineation of various lesion images. With the accumulation of enormous medical records, the evolution of computation power with graphic processing units, and the widespread use of open-source libraries in large-scale machine learning processes, medical artificial intelligence is overcoming its traditional limitations. This paper explains the basic concepts of deep learning model establishment and summarizes previous studies on upper gastrointestinal disorders. The limitations and perspectives on future development are also discussed.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
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7
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Bang CS, Lee JJ, Baik GH. Computer-aided diagnosis of esophageal cancer and neoplasms in endoscopic images: a systematic review and meta-analysis of diagnostic test accuracy. Gastrointest Endosc 2021; 93:1006-1015.e13. [PMID: 33290771 DOI: 10.1016/j.gie.2020.11.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Diagnosis of esophageal cancer or precursor lesions by endoscopic imaging depends on endoscopist expertise and is inevitably subject to interobserver variability. Studies on computer-aided diagnosis (CAD) using deep learning or machine learning are on the increase. However, studies with small sample sizes are limited by inadequate statistical strength. Here, we used a meta-analysis to evaluate the diagnostic test accuracy (DTA) of CAD algorithms of esophageal cancers or neoplasms using endoscopic images. METHODS Core databases were searched for studies based on endoscopic imaging using CAD algorithms for the diagnosis of esophageal cancer or neoplasms and presenting data on diagnostic performance, and a systematic review and DTA meta-analysis were performed. RESULTS Overall, 21 and 19 studies were included in the systematic review and DTA meta-analysis, respectively. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD algorithms for the diagnosis of esophageal cancer or neoplasms in the image-based analysis were 0.97 (95% confidence interval [CI], 0.95-0.99), 0.94 (95% CI, 0.89-0.96), 0.88 (95% CI, 0.76-0.94), and 108 (95% CI, 43-273), respectively. Meta-regression showed no heterogeneity, and no publication bias was detected. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD algorithms for the diagnosis of esophageal cancer invasion depth were 0.96 (95% CI, 0.86-0.99), 0.90 (95% CI, 0.88-0.92), 0.88 (95% CI, 0.83-0.91), and 138 (95% CI, 12-1569), respectively. CONCLUSIONS CAD algorithms showed high accuracy for the automatic endoscopic diagnosis of esophageal cancer and neoplasms. The limitation of a lack in performance in external validation and clinical applications should be overcome.
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Affiliation(s)
- Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea; Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Korea; Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea; Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea; Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Chuncheon, Korea; Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea; Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Korea
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8
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Yang H, Hu B. Application of artificial intelligence to endoscopy on common gastrointestinal benign diseases. Artif Intell Gastrointest Endosc 2021; 2:25-35. [DOI: 10.37126/aige.v2.i2.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/17/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) has been widely involved in every aspect of healthcare in the preclinical stage. In the digestive system, AI has been trained to assist auxiliary examinations including histopathology, endoscopy, ultrasonography, computerized tomography, and magnetic resonance imaging in detection, diagnosis, classification, differentiation, prognosis, and quality control. In the field of endoscopy, the application of AI, such as automatic detection, diagnosis, classification, and invasion depth, in early gastrointestinal (GI) cancers has received wide attention. There is a paucity of studies of AI application on common GI benign diseases based on endoscopy. In the review, we provide an overview of AI applications to endoscopy on common GI benign diseases including in the esophagus, stomach, intestine, and colon. It indicates that AI will gradually become an indispensable part of normal endoscopic detection and diagnosis of common GI benign diseases as clinical data, algorithms, and other related work are constantly repeated and improved.
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Affiliation(s)
- Hang Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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9
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Xu Y, Ding W, Wang Y, Tan Y, Xi C, Ye N, Wu D, Xu X. Comparison of diagnostic performance between convolutional neural networks and human endoscopists for diagnosis of colorectal polyp: A systematic review and meta-analysis. PLoS One 2021; 16:e0246892. [PMID: 33592048 PMCID: PMC7886136 DOI: 10.1371/journal.pone.0246892] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
Prospective randomized trials and observational studies have revealed that early detection, classification, and removal of neoplastic colorectal polyp (CP) significantly improve the prevention of colorectal cancer (CRC). The current effectiveness of the diagnostic performance of colonoscopy remains unsatisfactory with unstable accuracy. The convolutional neural networks (CNN) system based on artificial intelligence (AI) technology has demonstrated its potential to help endoscopists in increasing diagnostic accuracy. Nonetheless, several limitations of the CNN system and controversies exist on whether it provides a better diagnostic performance compared to human endoscopists. Therefore, this study sought to address this issue. Online databases (PubMed, Web of Science, Cochrane Library, and EMBASE) were used to search for studies conducted up to April 2020. Besides, the quality assessment of diagnostic accuracy scale-2 (QUADAS-2) was used to evaluate the quality of the enrolled studies. Moreover, publication bias was determined using the Deeks’ funnel plot. In total, 13 studies were enrolled for this meta-analysis (ranged between 2016 and 2020). Consequently, the CNN system had a satisfactory diagnostic performance in the field of CP detection (sensitivity: 0.848 [95% CI: 0.692–0.932]; specificity: 0.965 [95% CI: 0.946–0.977]; and AUC: 0.98 [95% CI: 0.96–0.99]) and CP classification (sensitivity: 0.943 [95% CI: 0.927–0.955]; specificity: 0.894 [95% CI: 0.631–0.977]; and AUC: 0.95 [95% CI: 0.93–0.97]). In comparison with human endoscopists, the CNN system was comparable to the expert but significantly better than the non-expert in the field of CP classification (CNN vs. expert: RDOR: 1.03, P = 0.9654; non-expert vs. expert: RDOR: 0.29, P = 0.0559; non-expert vs. CNN: 0.18, P = 0.0342). Therefore, the CNN system exhibited a satisfactory diagnostic performance for CP and could be used as a potential clinical diagnostic tool during colonoscopy.
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Affiliation(s)
- Yixin Xu
- Department of General Surgery, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu Province, China
| | - Wei Ding
- Department of General Surgery, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu Province, China
| | - Yibo Wang
- Department of General Surgery, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu Province, China
| | - Yulin Tan
- Department of General Surgery, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu Province, China
| | - Cheng Xi
- Department of General Surgery, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu Province, China
| | - Nianyuan Ye
- Department of General Surgery, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu Province, China
| | - Dapeng Wu
- Department of Endoscopy, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Xuezhong Xu
- Department of General Surgery, Changzhou Wujin People’s Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu Province, China
- * E-mail:
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10
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Sehgal V, Ragunath K, Haidry R. Measuring Quality in Barrett's Esophagus: Time to Embrace Quality Indicators. Gastrointest Endosc Clin N Am 2021; 31:219-236. [PMID: 33213797 DOI: 10.1016/j.giec.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic eradication therapy is a safe and effective therapy that has revolutionized the management of patients with Barrett's esophagus (BE)-related neoplasia. Despite this, there remains significant heterogeneity in clinical practice with consequent variation in patient outcomes. The aim of this article was to align consensus statements based on the best available evidence and expert opinion from the United States and United Kingdom to develop robust and measurable quality indicators that help to ensure patients with BE-related neoplasia receive the highest possible quality of care uniformly.
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Affiliation(s)
- Vinay Sehgal
- Department of Gastroenterology and Endoscopy, University College London Hospitals NHS Foundation Trust, Ground Floor West, 250 Euston Road, London NW1 2PG, UK.
| | - Krish Ragunath
- Department of Gastroenterology, Curtin University Medical School, Royal Perth Hospital, Victoria Square, Perth, Western Australia 6000, Australia
| | - Rehan Haidry
- Department of Gastroenterology and Endoscopy, University College London Hospitals NHS Foundation Trust, Ground Floor West, 250 Euston Road, London NW1 2PG, UK
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11
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Sinonquel P, Bisschops R. Striving for quality improvement: can artificial intelligence help? Best Pract Res Clin Gastroenterol 2020; 52-53:101722. [PMID: 34172249 DOI: 10.1016/j.bpg.2020.101722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023]
Abstract
Artificial intelligence (AI) is of keen interest for global health development as potential support for current human shortcomings. Gastrointestinal (GI) endoscopy is an excellent substrate for AI, since it holds the genuine potential to improve quality in GI endoscopy and overall patient care by improving detection and diagnosis guiding the endoscopists in performing endoscopy to the highest quality standards. The possibility of large data acquisitioning to refine algorithms makes implementation of AI into daily practice a potential reality. With the start of a new era adopting deep learning, large amounts of data can easily be processed, resulting in better diagnostic performances. In the upper gastrointestinal tract, research currently focusses on the detection and characterization of neoplasia, including Barrett's, squamous cell and gastric carcinoma, with an increasing amount of AI studies demonstrating the potential and benefit of AI-augmented endoscopy. Deep learning applied to small bowel video capsule endoscopy also appears to enhance pathology detection and reduce capsule reading time. In the colon, multiple prospective trials including five randomized trials, showed a consistent improvement in polyp and adenoma detection rates, one of the main quality indicators in endoscopy. There are however potential additional roles for AI to assist in quality improvement of endoscopic procedures, training and therapeutic decision making. Further large-scale, multicenter validation trials are required before AI-augmented diagnostic gastrointestinal endoscopy can be integrated into our routine clinical practice.
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Affiliation(s)
- P Sinonquel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Department of Translational Research in Gastrointestinal Diseases (TARGID), Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - R Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Department of Translational Research in Gastrointestinal Diseases (TARGID), Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium.
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12
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A Gratifying Step forward for the Application of Artificial Intelligence in the Field of Endoscopy: A Narrative Review. Surg Laparosc Endosc Percutan Tech 2020; 31:254-263. [PMID: 33122593 PMCID: PMC8132898 DOI: 10.1097/sle.0000000000000881] [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: 08/05/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
Endoscopy is the optimal choice of diagnosis of gastrointestinal (GI) diseases. Following the advancements made in medical technology, different kinds of novel endoscopy-methods have emerged. Although the significant progress in the penetration of endoscopic tools that have markedly improved the diagnostic rate of GI diseases, there are still some limitations, including instability of human diagnostic performance caused by intensive labor burden and high missed diagnosis rate of subtle lesions. Recently, artificial intelligence (AI) has been applied gradually to assist endoscopists in addressing these issues.
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Hussein M, González-Bueno Puyal J, Mountney P, Lovat LB, Haidry R. Role of artificial intelligence in the diagnosis of oesophageal neoplasia: 2020 an endoscopic odyssey. World J Gastroenterol 2020; 26:5784-5796. [PMID: 33132634 PMCID: PMC7579761 DOI: 10.3748/wjg.v26.i38.5784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/12/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
The past decade has seen significant advances in endoscopic imaging and optical enhancements to aid early diagnosis. There is still a treatment gap due to the underdiagnosis of lesions of the oesophagus. Computer aided diagnosis may play an important role in the coming years in providing an adjunct to endoscopists in the early detection and diagnosis of early oesophageal cancers, therefore curative endoscopic therapy can be offered. Research in this area of artificial intelligence is expanding and the future looks promising. In this review article we will review current advances in artificial intelligence in the oesophagus and future directions for development.
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Affiliation(s)
- Mohamed Hussein
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Division of Surgery and Interventional Sciences, University College London, London W1W 7TY, United Kingdom
| | - Juana González-Bueno Puyal
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, United Kingdom and Odin Vision, London W1W 7TS, United Kingdom
| | | | - Laurence B Lovat
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Division of Surgery and Interventional Sciences, University College London, London W1W 7TY, United Kingdom
| | - Rehan Haidry
- Department of GI Services, University College London Hospital, London NW1 2BU, United Kingdom
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The Impact of Artificial Intelligence in the Endoscopic Assessment of Premalignant and Malignant Esophageal Lesions: Present and Future. ACTA ACUST UNITED AC 2020; 56:medicina56070364. [PMID: 32708343 PMCID: PMC7404688 DOI: 10.3390/medicina56070364] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
In the gastroenterology field, the impact of artificial intelligence was investigated for the purposes of diagnostics, risk stratification of patients, improvement in quality of endoscopic procedures and early detection of neoplastic diseases, implementation of the best treatment strategy, and optimization of patient prognosis. Computer-assisted diagnostic systems to evaluate upper endoscopy images have recently emerged as a supporting tool in endoscopy due to the risks of misdiagnosis related to standard endoscopy and different expertise levels of endoscopists, time-consuming procedures, lack of availability of advanced procedures, increasing workloads, and development of endoscopic mass screening programs. Recent research has tended toward computerized, automatic, and real-time detection of lesions, which are approaches that offer utility in daily practice. Despite promising results, certain studies might overexaggerate the diagnostic accuracy of artificial systems, and several limitations remain to be overcome in the future. Therefore, additional multicenter randomized trials and the development of existent database platforms are needed to certify clinical implementation. This paper presents an overview of the literature and the current knowledge of the usefulness of different types of machine learning systems in the assessment of premalignant and malignant esophageal lesions via conventional and advanced endoscopic procedures. This study makes a presentation of the artificial intelligence terminology and refers also to the most prominent recent research on computer-assisted diagnosis of neoplasia on Barrett’s esophagus and early esophageal squamous cell carcinoma, and prediction of invasion depth in esophageal neoplasms. Furthermore, this review highlights the main directions of future doctor–computer collaborations in which machines are expected to improve the quality of medical action and routine clinical workflow, thus reducing the burden on physicians.
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Watts AE, Cotton CC, Shaheen NJ. Radiofrequency Ablation of Barrett's Esophagus: Have We Gone Too Far, or Not Far Enough? Curr Gastroenterol Rep 2020; 22:29. [PMID: 32383077 DOI: 10.1007/s11894-020-00766-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE OF REVIEW Barrett's esophagus (BE) is a premalignant condition of the esophagus associated with an increased risk for esophageal adenocarcinoma (EAC). Radiofrequency ablation (RFA) is a safe and effective first-line treatment for dysplastic BE and early stage EAC. This report reviews clinically relevant evidence published over the last 3 years regarding RFA for BE. RECENT FINDINGS Our use of this technology has simultaneously gone too far, in that many patients who may not derive a benefit from these treatments are receiving them, and not far enough, in that many patients who would be eligible for ablative therapy never undergo screening exams to assess them for dysplastic BE, or do not have endoscopic therapy considered part of the treatment of superficial invasive cancer. Research to better identify patients with BE, risk stratify those patients, improve the quality of RFA treatment, and inform surveillance practices has the potential to optimize the benefit of RFA, and minimize the harms, costs, and risks.
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Affiliation(s)
- Ariel E Watts
- Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cary C Cotton
- Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicholas J Shaheen
- Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Picardo S, Ragunath K. Artificial intelligence in endoscopy: the guardian angel is around the corner. Gastrointest Endosc 2020; 91:340-341. [PMID: 32036941 DOI: 10.1016/j.gie.2019.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Sherman Picardo
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia
| | - Krish Ragunath
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia; Curtain Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
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Gulati S, Emmanuel A, Patel M, Williams S, Haji A, Hayee B, Neumann H. Artificial intelligence in luminal endoscopy. Ther Adv Gastrointest Endosc 2020; 13:2631774520935220. [PMID: 32637935 PMCID: PMC7315657 DOI: 10.1177/2631774520935220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence is a strong focus of interest for global health development. Diagnostic endoscopy is an attractive substrate for artificial intelligence with a real potential to improve patient care through standardisation of endoscopic diagnosis and to serve as an adjunct to enhanced imaging diagnosis. The possibility to amass large data to refine algorithms makes adoption of artificial intelligence into global practice a potential reality. Initial studies in luminal endoscopy involve machine learning and are retrospective. Improvement in diagnostic performance is appreciable through the adoption of deep learning. Research foci in the upper gastrointestinal tract include the diagnosis of neoplasia, including Barrett's, squamous cell and gastric where prospective and real-time artificial intelligence studies have been completed demonstrating a benefit of artificial intelligence-augmented endoscopy. Deep learning applied to small bowel capsule endoscopy also appears to enhance pathology detection and reduce capsule reading time. Prospective evaluation including the first randomised trial has been performed in the colon, demonstrating improved polyp and adenoma detection rates; however, these appear to be relevant to small polyps. There are potential additional roles of artificial intelligence relevant to improving the quality of endoscopic examinations, training and triaging of referrals. Further large-scale, multicentre and cross-platform validation studies are required for the robust incorporation of artificial intelligence-augmented diagnostic luminal endoscopy into our routine clinical practice.
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Affiliation(s)
- Shraddha Gulati
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Andrew Emmanuel
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Mehul Patel
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Sophie Williams
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Amyn Haji
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Bu’Hussain Hayee
- King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
| | - Helmut Neumann
- Department of Interdisciplinary Endoscopy, University Hospital Mainz, 55131 Mainz, Germany
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