• Aims Third-space endoscopy procedures such as endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are complex interventions with elevated risk of operator-dependent adverse events, such as intra-procedural bleeding and perforation. We aimed to design an artificial intelligence clinical decision support solution (AI-CDSS, “Smart ESD”) for the detection and delineation of vessels, tissue structures, and instruments during third-space endoscopy procedures. Methods Twelve full-length third-space endoscopy videos were extracted from the Augsburg University Hospital database. 1686 frames were annotated for the following categories: Submucosal layer, blood vessels, electrosurgical knife and endoscopic instrument. A DeepLabv3+neural network with a 101-layer ResNet backbone was trained and validated internally. Finally, the ability of the AI system to detect visible vessels during ESD and POEM was determined on 24 separate video clips of 7 to 46 seconds duration and showing 33 predefined vessels. These video clips were also assessed by an expert in third-space endoscopy. Results Smart ESD showed a vessel detection rate (VDR) of 93.94%, while an average of 1.87 false positive signals were recorded per minute. VDR of the expert endoscopist was 90.1% with no false positive findings. On the internal validation data set using still images, the AI system demonstrated an Intersection over Union (IoU), mean Dice score and pixel accuracy of 63.47%, 76.18% and 86.61%, respectively. Conclusions This is the first AI-CDSS aiming to mitigate operator-dependent limitations during third-space endoscopy. Further clinical trials are underway to better understand the role of AI in such procedures.

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Author:Markus W. ScheppachORCiD, Robert MendelORCiD, Andreas Probst, Michael Meinikheim, Christoph PalmORCiDGND, Helmut Messmann, Alanna EbigboORCiD
Parent Title (English):Endoscopy
Document Type:Article
Year of first Publication:2022
Release Date:2022/04/20
Tag:Artificial Intelligence; Smart ESD; Third-Space Endoscopy
First Page:S175
Konferenzangabe:ESGE Days 2022
Institutes:Fakultät Informatik und Mathematik
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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