Endoscopic Diagnosis of Eosinophilic Esophagitis Using a deep Learning Algorithm

  • Aims Eosinophilic esophagitis (EoE) is easily missed during endoscopy, either because physicians are not familiar with its endoscopic features or the morphologic changes are too subtle. In this preliminary paper, we present the first attempt to detect EoE in endoscopic white light (WL) images using a deep learning network (EoE-AI). Methods 401 WL images of eosinophilic esophagitis and 871 WL images of normal esophageal mucosa were evaluated. All images were assessed for the Endoscopic Reference score (EREFS) (edema, rings, exudates, furrows, strictures). Images with strictures were excluded. EoE was defined as the presence of at least 15 eosinophils per high power field on biopsy. A convolutional neural network based on the ResNet architecture with several five-fold cross-validation runs was used. Adding auxiliary EREFS-classification branches to the neural network allowed the inclusion of the scores as optimization criteria during training. EoE-AI was evaluated for sensitivity, specificity, and F1-score. In addition, two human endoscopists evaluated the images. Results EoE-AI showed a mean sensitivity, specificity, and F1 of 0.759, 0.976, and 0.834 respectively, averaged over the five distinct cross-validation runs. With the EREFS-augmented architecture, a mean sensitivity, specificity, and F1-score of 0.848, 0.945, and 0.861 could be demonstrated respectively. In comparison, the two human endoscopists had an average sensitivity, specificity, and F1-score of 0.718, 0.958, and 0.793. Conclusions To the best of our knowledge, this is the first application of deep learning to endoscopic images of EoE which were also assessed after augmentation with the EREFS-score. The next step is the evaluation of EoE-AI using an external dataset. We then plan to assess the EoE-AI tool on endoscopic videos, and also in real-time. This preliminary work is encouraging regarding the ability for AI to enhance physician detection of EoE, and potentially to do a true “optical biopsy” but more work is needed.

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Author:Christoph Römmele, Robert MendelORCiD, David Rauber, Tobias RückertORCiD, Michael F. Byrne, Christoph PalmORCiDGND, Helmut Messmann, Alanna EbigboORCiD
Parent Title (English):Endoscopy
Publisher:Georg Thieme Verlag
Place of publication:Stuttgart
Document Type:conference proceeding (presentation, abstract)
Year of first Publication:2021
Release Date:2021/07/30
Tag:Deep Learning; Endoscopy; Eosinophilic Esophagitis
Issue:S 01
Article Number:S10
Konferenzangabe:ESGE Days 2021
Institutes:Fakultät Informatik und Mathematik
Regensburg Center of Health Sciences and Technology - RCHST
Fakultät Informatik und Mathematik / Regensburg Medical Image Computing (ReMIC)
research focus:Lebenswissenschaften und Ethik
Licence (German):Keine Lizenz - Es gilt das deutsche Urheberrecht: § 53 UrhG
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