Deep Learning and Device-Assisted Enteroscopy: Automatic Detection of Gastrointestinal Angioectasia

From Data to Insights: How Is AI Revolutionizing Small-Bowel Endoscopy?

The role of capsule endoscopy and enteroscopy in managing various small-bowel pathologies is well-established. However, their broader application has been hampered mainly by their lengthy reading times. As a result, there is a growing interest in employing artificial intelligence (AI) in these diagnostic and therapeutic procedures, driven by the prospect of overcoming some major limitations and enhancing healthcare efficiency, while maintaining high accuracy levels. In the past two decades, the applicability of AI to gastroenterology has been increasing, mainly because of the strong imaging component. Nowadays, there are a multitude of studies using AI, specifically using convolutional neural networks, that prove the potential applications of AI to these endoscopic techniques, achieving remarkable results. These findings suggest that there is ample opportunity for AI to expand its presence in the management of gastroenterology diseases and, in the future, catalyze a game-changing transformation in clinical activities. This review provides an overview of the current state-of-the-art of AI in the scope of small-bowel study, with a particular focus on capsule endoscopy and enteroscopy.

Automatic detection of small bowel lesions with different bleeding risks based on deep learning models

BACKGROUND

Deep learning provides an efficient automatic image recognition method for small bowel (SB) capsule endoscopy (CE) that can assist physicians in diagnosis. However, the existing deep learning models present some unresolved challenges.

AIM

To propose a novel and effective classification and detection model to automatically identify various SB lesions and their bleeding risks, and label the lesions accurately so as to enhance the diagnostic efficiency of physicians and the ability to identify high-risk bleeding groups.

METHODS

The proposed model represents a two-stage method that combined image classification with object detection. First, we utilized the improved ResNet-50 classification model to classify endoscopic images into SB lesion images, normal SB mucosa images, and invalid images. Then, the improved YOLO-V5 detection model was utilized to detect the type of lesion and its risk of bleeding, and the location of the lesion was marked. We constructed training and testing sets and compared model-assisted reading with physician reading.

RESULTS

The accuracy of the model constructed in this study reached 98.96%, which was higher than the accuracy of other systems using only a single module. The sensitivity, specificity, and accuracy of the model-assisted reading detection of all images were 99.17%, 99.92%, and 99.86%, which were significantly higher than those of the endoscopists' diagnoses. The image processing time of the model was 48 ms/image, and the image processing time of the physicians was 0.40 ± 0.24 s/image (P < 0.001).

CONCLUSION

The deep learning model of image classification combined with object detection exhibits a satisfactory diagnostic effect on a variety of SB lesions and their bleeding risks in CE images, which enhances the diagnostic efficiency of physicians and improves the ability of physicians to identify high-risk bleeding groups.

A newly developed deep learning-based system for automatic detection and classification of small bowel lesions during double-balloon enteroscopy examination

BACKGROUND

Double-balloon enteroscopy (DBE) is a standard method for diagnosing and treating small bowel disease. However, DBE may yield false-negative results due to oversight or inexperience. We aim to develop a computer-aided diagnostic (CAD) system for the automatic detection and classification of small bowel abnormalities in DBE.

DESIGN AND METHODS

A total of 5201 images were collected from Renmin Hospital of Wuhan University to construct a detection model for localizing lesions during DBE, and 3021 images were collected to construct a classification model for classifying lesions into four classes, protruding lesion, diverticulum, erosion & ulcer and angioectasia. The performance of the two models was evaluated using 1318 normal images and 915 abnormal images and 65 videos from independent patients and then compared with that of 8 endoscopists. The standard answer was the expert consensus.

RESULTS

For the image test set, the detection model achieved a sensitivity of 92% (843/915) and an area under the curve (AUC) of 0.947, and the classification model achieved an accuracy of 86%. For the video test set, the accuracy of the system was significantly better than that of the endoscopists (85% vs. 77 ± 6%, p < 0.01). For the video test set, the proposed system was superior to novices and comparable to experts.

CONCLUSIONS

We established a real-time CAD system for detecting and classifying small bowel lesions in DBE with favourable performance. ENDOANGEL-DBE has the potential to help endoscopists, especially novices, in clinical practice and may reduce the miss rate of small bowel lesions.

Artificial Intelligence and Panendoscopy-Automatic Detection of Clinically Relevant Lesions in Multibrand Device-Assisted Enteroscopy

Device-assisted enteroscopy (DAE) is capable of evaluating the entire gastrointestinal tract, identifying multiple lesions. Nevertheless, DAE's diagnostic yield is suboptimal. Convolutional neural networks (CNN) are multi-layer architecture artificial intelligence models suitable for image analysis, but there is a lack of studies about their application in DAE. Our group aimed to develop a multidevice CNN for panendoscopic detection of clinically relevant lesions during DAE. In total, 338 exams performed in two specialized centers were retrospectively evaluated, with 152 single-balloon enteroscopies (Fujifilm®, Porto, Portugal), 172 double-balloon enteroscopies (Olympus®, Porto, Portugal) and 14 motorized spiral enteroscopies (Olympus®, Porto, Portugal); then, 40,655 images were divided in a training dataset (90% of the images, n = 36,599) and testing dataset (10% of the images, n = 4066) used to evaluate the model. The CNN's output was compared to an expert consensus classification. The model was evaluated by its sensitivity, specificity, positive (PPV) and negative predictive values (NPV), accuracy and area under the precision recall curve (AUC-PR). The CNN had an 88.9% sensitivity, 98.9% specificity, 95.8% PPV, 97.1% NPV, 96.8% accuracy and an AUC-PR of 0.97. Our group developed the first multidevice CNN for panendoscopic detection of clinically relevant lesions during DAE. The development of accurate deep learning models is of utmost importance for increasing the diagnostic yield of DAE-based panendoscopy.

Smart Endoscopy Is Greener Endoscopy: Leveraging Artificial Intelligence and Blockchain Technologies to Drive Sustainability in Digestive Health Care

The surge in the implementation of artificial intelligence (AI) in recent years has permeated many aspects of our life, and health care is no exception. Whereas this technology can offer clear benefits, some of the problems associated with its use have also been recognised and brought into question, for example, its environmental impact. In a similar fashion, health care also has a significant environmental impact, and it requires a considerable source of greenhouse gases. Whereas efforts are being made to reduce the footprint of AI tools, here, we were specifically interested in how employing AI tools in gastroenterology departments, and in particular in conjunction with capsule endoscopy, can reduce the carbon footprint associated with digestive health care while offering improvements, particularly in terms of diagnostic accuracy. We address the different ways that leveraging AI applications can reduce the carbon footprint associated with all types of capsule endoscopy examinations. Moreover, we contemplate how the incorporation of other technologies, such as blockchain technology, into digestive health care can help ensure the sustainability of this clinical speciality and by extension, health care in general.

Enteroscopy versus Video Capsule Endoscopy for Automatic Diagnosis of Small Bowel Disorders-A Comparative Analysis of Artificial Intelligence Applications

BACKGROUND

Small bowel disorders present a diagnostic challenge due to the limited accessibility of the small intestine. Accurate diagnosis is made with the aid of specific procedures, like capsule endoscopy or double-ballon enteroscopy, but they are not usually solicited and not widely accessible. This study aims to assess and compare the diagnostic effectiveness of enteroscopy and video capsule endoscopy (VCE) when combined with artificial intelligence (AI) algorithms for the automatic detection of small bowel diseases.

MATERIALS AND METHODS

We performed an extensive literature search for relevant studies about AI applications capable of identifying small bowel disorders using enteroscopy and VCE, published between 2012 and 2023, employing PubMed, Cochrane Library, Google Scholar, Embase, Scopus, and ClinicalTrials.gov databases.

RESULTS

Our investigation discovered a total of 27 publications, out of which 21 studies assessed the application of VCE, while the remaining 6 articles analyzed the enteroscopy procedure. The included studies portrayed that both investigations, enhanced by AI, exhibited a high level of diagnostic accuracy. Enteroscopy demonstrated superior diagnostic capability, providing precise identification of small bowel pathologies with the added advantage of enabling immediate therapeutic intervention. The choice between these modalities should be guided by clinical context, patient preference, and resource availability. Studies with larger sample sizes and prospective designs are warranted to validate these results and optimize the integration of AI in small bowel diagnostics.

CONCLUSIONS

The current analysis demonstrates that both enteroscopy and VCE with AI augmentation exhibit comparable diagnostic performance for the automatic detection of small bowel disorders.

Deep-Learning and Device-Assisted Enteroscopy: Automatic Panendoscopic Detection of Ulcers and Erosions

Background and Objectives: Device-assisted enteroscopy (DAE) has a significant role in approaching enteric lesions. Endoscopic observation of ulcers or erosions is frequent and can be associated with many nosological entities, namely Crohn's disease. Although the application of artificial intelligence (AI) is growing exponentially in various imaged-based gastroenterology procedures, there is still a lack of evidence of the AI technical feasibility and clinical applicability of DAE. This study aimed to develop and test a multi-brand convolutional neural network (CNN)-based algorithm for automatically detecting ulcers and erosions in DAE. Materials and Methods: A unicentric retrospective study was conducted for the development of a CNN, based on a total of 250 DAE exams. A total of 6772 images were used, of which 678 were considered ulcers or erosions after double-validation. Data were divided into a training and a validation set, the latter being used for the performance assessment of the model. Our primary outcome measures were sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and an area under the curve precision-recall curve (AUC-PR). Results: Sensitivity, specificity, PPV, and NPV were respectively 88.5%, 99.7%, 96.4%, and 98.9%. The algorithm's accuracy was 98.7%. The AUC-PR was 1.00. The CNN processed 293.6 frames per second, enabling AI live application in a real-life clinical setting in DAE. Conclusion: To the best of our knowledge, this is the first study regarding the automatic multi-brand panendoscopic detection of ulcers and erosions throughout the digestive tract during DAE, overcoming a relevant interoperability challenge. Our results highlight that using a CNN to detect this type of lesion is associated with high overall accuracy. The development of binary CNN for automatically detecting clinically relevant endoscopic findings and assessing endoscopic inflammatory activity are relevant steps toward AI application in digestive endoscopy, particularly for panendoscopic evaluation.

Deep Learning Multi-Domain Model Provides Accurate Detection and Grading of Mucosal Ulcers in Different Capsule Endoscopy Types

Background and Aims: The aim of our study was to create an accurate patient-level combined algorithm for the identification of ulcers on CE images from two different capsules. Methods: We retrospectively collected CE images from PillCam-SB3′s capsule and PillCam-Crohn’s capsule. ML algorithms were trained to classify small bowel CE images into either normal or ulcerated mucosa: a separate model for each capsule type, a cross-domain model (training the model on one capsule type and testing on the other), and a combined model. Results: The dataset included 33,100 CE images: 20,621 PillCam-SB3 images and 12,479 PillCam-Crohn’s images, of which 3582 were colonic images. There were 15,684 normal mucosa images and 17,416 ulcerated mucosa images. While the separate model for each capsule type achieved excellent accuracy (average AUC 0.95 and 0.98, respectively), the cross-domain model achieved a wide range of accuracies (0.569–0.88) with an AUC of 0.93. The combined model achieved the best results with an average AUC of 0.99 and average mean patient accuracy of 0.974. Conclusions: A combined model for two different capsules provided high and consistent diagnostic accuracy. Creating a holistic AI model for automated capsule reading is an essential part of the refinement required in ML models on the way to adapting them to clinical practice.

Malignant Bone Tumors Diagnosis Using Magnetic Resonance Imaging Based on Deep Learning Algorithms

Background and Objectives: Malignant bone tumors represent a major problem due to their aggressiveness and low survival rate. One of the determining factors for improving vital and functional prognosis is the shortening of the time between the onset of symptoms and the moment when treatment starts. The objective of the study is to predict the malignancy of a bone tumor from magnetic resonance imaging (MRI) using deep learning algorithms. Materials and Methods: The cohort contained 23 patients in the study (14 women and 9 men with ages between 15 and 80). Two pretrained ResNet50 image classifiers are used to classify T1 and T2 weighted MRI scans. To predict the malignancy of a tumor, a clinical model is used. The model is a feed forward neural network whose inputs are patient clinical data and the output values of T1 and T2 classifiers. Results: For the training step, the accuracies of 93.67% for the T1 classifier and 86.67% for the T2 classifier were obtained. In validation, both classifiers obtained 95.00% accuracy. The clinical model had an accuracy of 80.84% for training phase and 80.56% for validation. The receiver operating characteristic curve (ROC) of the clinical model shows that the algorithm can perform class separation. Conclusions: The proposed method is based on pretrained deep learning classifiers which do not require a manual segmentation of the MRI images. These algorithms can be used to predict the malignancy of a tumor and on the other hand can shorten the time of their diagnosis and treatment process. While the proposed method requires minimal intervention from an imagist, it needs to be tested on a larger cohort of patients.