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Cuevas-Rodriguez EO, Galvan-Tejada CE, Maeda-Gutiérrez V, Moreno-Chávez G, Galván-Tejada JI, Gamboa-Rosales H, Luna-García H, Moreno-Baez A, Celaya-Padilla JM. Comparative study of convolutional neural network architectures for gastrointestinal lesions classification. PeerJ 2023; 11:e14806. [PMID: 36945355 PMCID: PMC10024900 DOI: 10.7717/peerj.14806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/05/2023] [Indexed: 03/18/2023] Open
Abstract
The gastrointestinal (GI) tract can be affected by different diseases or lesions such as esophagitis, ulcers, hemorrhoids, and polyps, among others. Some of them can be precursors of cancer such as polyps. Endoscopy is the standard procedure for the detection of these lesions. The main drawback of this procedure is that the diagnosis depends on the expertise of the doctor. This means that some important findings may be missed. In recent years, this problem has been addressed by deep learning (DL) techniques. Endoscopic studies use digital images. The most widely used DL technique for image processing is the convolutional neural network (CNN) due to its high accuracy for modeling complex phenomena. There are different CNNs that are characterized by their architecture. In this article, four architectures are compared: AlexNet, DenseNet-201, Inception-v3, and ResNet-101. To determine which architecture best classifies GI tract lesions, a set of metrics; accuracy, precision, sensitivity, specificity, F1-score, and area under the curve (AUC) were used. These architectures were trained and tested on the HyperKvasir dataset. From this dataset, a total of 6,792 images corresponding to 10 findings were used. A transfer learning approach and a data augmentation technique were applied. The best performing architecture was DenseNet-201, whose results were: 97.11% of accuracy, 96.3% sensitivity, 99.67% specificity, and 95% AUC.
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Gubbiotti A, Spadaccini M, Badalamenti M, Hassan C, Repici A. Key factors for improving adenoma detection rate. Expert Rev Gastroenterol Hepatol 2022; 16:819-833. [PMID: 36151898 DOI: 10.1080/17474124.2022.2128761] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Colonoscopy is a fundamental tool in colorectal cancer (CRC) prevention. Nevertheless, one-fourth of colorectal neoplasms are still missed during colonoscopy, potentially being the main reason for post-colonoscopy colorectal cancer (PCCRC). Adenoma detection rate (ADR) is currently known as the best quality indicator correlating with PCCRC incidence. AREAS COVERED We performed a literature review in order to summarize evidences investigating key factors affecting ADR: endoscopists education and training, patient management, endoscopic techniques, improved navigation (exposition defect), and enhanced lesions recognition (vision defect) were considered. EXPERT OPINION 'Traditional' factors, such as split dose bowel preparation, adequate withdrawal time, and right colon second view, held a significant impact on ADR. Several devices and technologies have been developed to promote high-quality colonoscopy, however artificial intelligence may be considered the most promising tool for ADR improvement, provided that endoscopists education and recording are guaranteed.
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Affiliation(s)
- Alessandro Gubbiotti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Marco Spadaccini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Matteo Badalamenti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Italy
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Iqbal A, Sharif M, Khan MA, Nisar W, Alhaisoni M. FF-UNet: a U-Shaped Deep Convolutional Neural Network for Multimodal Biomedical Image Segmentation. Cognit Comput 2022. [DOI: 10.1007/s12559-022-10038-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Seo JH, Lee BI, Lee K, Park JM, Kim JS, Cho YS, Lee KM, Kim SW, Choi H, Choi MG. Adenoma miss rate of polypectomy-referring hospitals is high in Korea. Korean J Intern Med 2020; 35:881-888. [PMID: 31610632 PMCID: PMC7373960 DOI: 10.3904/kjim.2018.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/21/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas. METHODS We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary's Hospital obtained from May 2014 to February 2016. RESULTS A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively). CONCLUSION Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.
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Affiliation(s)
- Ju Hyun Seo
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Correspondence to Bo-In Lee, M.D Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-2044 Fax: +82-2-2258-2083 E-mail:
| | - Kyungjin Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jin Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young-Seok Cho
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kang-Moon Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sang Woo Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Hwang Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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Saxena A, Pauli EM, Haluck RS, Fell B, Moore J. Tubular Locomotion and Positioning Using Tip Eversion for Endoscopy. J Med Device 2020. [DOI: 10.1115/1.4046433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Abstract
Colonoscopy is a minimally invasive procedure to examine the large intestine using a flexible endoscope. Currently, colonoscopic procedures require physically pushing the endoscope through the large intestine which potentially imparts damaging forces on the intestinal wall, requires a high level of expertise to perform safely, and can require extensive procedure time. This paper presents the use of inverted tubular element locomotion (ITEL) for improved endoscope translation and positioning that works via tip eversion of inverted plastic tubes. Experiments were performed to examine the fluid pressure required for locomotion through a large intestinal model and in both straight and curved paths and determine the optimal tube dimensions for insertion via ITEL. Experiments were then performed to compare intestinal forces during manual and ITEL-based insertion. The experiments established a relationship between the tip eversion pressure and the tube thickness and diameter. In addition, it was found that pressure required for locomotion was only minimally impeded by being enclosed in the intestinal manikin but significantly impacted by the curvature of the turn. Measured insertion forces for ITEL were found to be 10.1% less compared to traditional insertion. These results will aid in the future design and development of ITEL for endoscopic positioning.
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Affiliation(s)
- Ankit Saxena
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA 16803
| | - Eric M. Pauli
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Randy S. Haluck
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Barry Fell
- Thermoplastic Products Corp., Hummelstown, PA 17036
| | - Jason Moore
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA 16802
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Wang W, Xu L, Bao Z, Sun L, Hu C, Zhou F, Xu L, Shi D. Differences with experienced nurse assistance during colonoscopy in detecting polyp and adenoma: a randomized clinical trial. Int J Colorectal Dis 2018. [PMID: 29541895 DOI: 10.1007/s00384-018-3003-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aims to evaluate whether the participation of an experienced endoscopy nurse in colonoscopy increases the polyp detection rate (PDR) and adenoma detection rate (ADR) of experienced colonoscopists. METHODS This study was a randomized controlled trial. Patients were randomly assigned to the experienced colonoscopist alone (single observer) group, or experienced nurse participation (dual observer) group. The primary outcome was the PDR and ADR. The advanced lesion detection rate was also recorded. RESULTS A total of 587 patients were included in the analysis. Among these patients, 291 patients were assigned to the single observer group, while 296 patients were assigned to the dual observer group. The PDR was 33% in the single observer group and 41.9% in the dual observer group (P = 0.026), while the ADR was 23.0% in the single observer group and 30.4% in the dual observer group (P = 0.043). No significant difference was found for advanced lesions between groups. CONCLUSIONS The present data demonstrated that experienced nurse observation during colonoscopy can improve polyp and adenoma detection rates, even if the colonoscopist is experienced. TRIAL REGISTRATION Clinicaltrials.gov No. NCT02292563. https://clinicaltrials.gov/ct2/results?cond=&term=NCT02292563&cntry=&state=&city=&dist=.
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Affiliation(s)
- Weihong Wang
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Lu Xu
- College of Medicine, Ningbo University, Ningbo, China
| | - Zhenfei Bao
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Linyin Sun
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Chunyan Hu
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Feng Zhou
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Lei Xu
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Dingmei Shi
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China.
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Lee J, Park SW, Kim YS, Lee KJ, Sung H, Song PH, Yoon WJ, Moon JS. Risk factors of missed colorectal lesions after colonoscopy. Medicine (Baltimore) 2017; 96:e7468. [PMID: 28682916 PMCID: PMC5502189 DOI: 10.1097/md.0000000000007468] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Several studies have reported a significant rate of missed colorectal polyps during colonoscopy. This study aimed to determine the variables that affect the miss rate of colorectal polyps.We performed a retrospective observational study of patients who, between January 2007 and December 2014, had undergone a second colonoscopy within 6 months of their first. In all patients, the first colonoscopy constituted a screening or surveillance colonoscopy as part of a health check-up, and the patients were referred to the endoscopic clinic if there were meaningful polyps. The miss rate of colorectal polyps was evaluated, as were the variables related to these missed lesions.Among 659 patients (535 men), the miss rate of colorectal polyps was 17.24% (372/2158 polyps), and 38.69% of patients (255/659 patients) had at least 1 missed polyp. The most common site for missed polyps was the ascending colon (29.8%), followed by the sigmoid colon (27.8%). The miss rate of polyps was higher in men [odds ratio (OR) = 1.611, 95% confidence interval (95% CI) = 1.024-2.536], patients with multiple polyps at their first colonoscopy (OR = 1.463, 95% CI = 0.992-2.157), and patients who had a history of polyps (OR = 23.783, 95% CI = 3.079-183.694). Multiple missed polyps were more frequently located in the right colon (OR = 2.605, 95% CI = 1.458-4.657), and the risk of sessile serrated adenoma/polyp was greater in the right colon (OR = 10.418, 95% CI = 2.073-52.353).Endoscopists should pay careful attention in patients who have multiple polyps and in those who have a history of polyps, because such patients are at a high risk of missed polyps in colonoscopy.
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Affiliation(s)
- Jeonghun Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul
- Department of Internal Medicine, Ace Hospital, Ansan, Korea
| | - Sung Won Park
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul
| | - You Sun Kim
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul
| | - Kyung Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul
| | - Hyun Sung
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul
| | - Pil Hun Song
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul
| | - Won Jae Yoon
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul
| | - Jeong Seop Moon
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul
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Yeo SH, Kwak JH, Kim YU, Kwon TH, Park JB, Park JH, Lee YK, Lim YJ, Yang CH. Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients: A Prospective Randomized Controlled Study. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 67:189-97. [DOI: 10.4166/kjg.2016.67.4.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Se Hwan Yeo
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Dongguk University College of Medicine, Korea
| | - Jae Hoon Kwak
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Dongguk University College of Medicine, Korea
| | - Yeo Un Kim
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Dongguk University College of Medicine, Korea
| | - Tae Ho Kwon
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Dongguk University College of Medicine, Korea
| | - Jeong Bae Park
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Dongguk University College of Medicine, Korea
| | - Jun Hyung Park
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Dongguk University College of Medicine, Korea
| | - Yong Kook Lee
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Dongguk University College of Medicine, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Dongguk University College of Medicine, Korea
| | - Chang Heon Yang
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Dongguk University College of Medicine, Korea
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Mahmud N, Cohen J, Tsourides K, Berzin TM. Computer vision and augmented reality in gastrointestinal endoscopy. Gastroenterol Rep (Oxf) 2015; 3:179-84. [PMID: 26133175 PMCID: PMC4527270 DOI: 10.1093/gastro/gov027] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/07/2015] [Indexed: 02/06/2023] Open
Abstract
Augmented reality (AR) is an environment-enhancing technology, widely applied in the computer sciences, which has only recently begun to permeate the medical field. Gastrointestinal endoscopy—which relies on the integration of high-definition video data with pathologic correlates—requires endoscopists to assimilate and process a tremendous amount of data in real time. We believe that AR is well positioned to provide computer-guided assistance with a wide variety of endoscopic applications, beginning with polyp detection. In this article, we review the principles of AR, describe its potential integration into an endoscopy set-up, and envisage a series of novel uses. With close collaboration between physicians and computer scientists, AR promises to contribute significant improvements to the field of endoscopy.
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Affiliation(s)
- Nadim Mahmud
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Jonah Cohen
- The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, USA
| | - Kleovoulos Tsourides
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Boston MA, USA
| | - Tyler M Berzin
- The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, USA
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Joo YE. [What are the factors influencing the miss rate of polyps in a tandem colonoscopic study?]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 64:1-3. [PMID: 25219025 DOI: 10.4166/kjg.2014.64.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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