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

Miguel Mascarenhas Saraiva,João Afonso,Hélder Cardoso,Tiago Ribeiro,João Ferreira,Pedro Cardoso,Patrícia Andrade,Guilherme Macedo

doi:10.3390/medicina57121378

Miguel Mascarenhas Saraiva, João Afonso + Show 6 more

Open Access

https://doi.org/10.3390/medicina57121378

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Abstract

Background and Objectives: Device-assisted enteroscopy (DAE) allows deep exploration of the small bowel and combines diagnostic and therapeutic capacities. Suspected mid-gastrointestinal bleeding is the most frequent indication for DAE, and vascular lesions, particularly angioectasia, are the most common etiology. Nevertheless, the diagnostic yield of DAE for the detection of these lesions is suboptimal. Deep learning algorithms have shown great potential for automatic detection of lesions in endoscopy. We aimed to develop an artificial intelligence (AI) model for the automatic detection of angioectasia DAE images. Materials and Methods: A convolutional neural network (CNN) was developed using DAE images. Each frame was labeled as normal/mucosa or angioectasia. The image dataset was split for the constitution of training and validation datasets. The latter was used for assessing the performance of the CNN. Results: A total of 72 DAE exams were included, and 6740 images were extracted (5345 of normal mucosa and 1395 of angioectasia). The model had a sensitivity of 88.5%, a specificity of 97.1% and an AUC of 0.988. The image processing speed was 6.4 ms/frame. Conclusions: The application of AI to DAE may have a significant impact on the management of patients with suspected mid-gastrointestinal bleeding.

Highlights

Obscure gastrointestinal bleeding (OGIB) comprises gastrointestinal bleeding without evident etiology after the performance of conventional esophagogastroduodenoscopy (EGD) and colonoscopy
Recent advances in imaging and endoscopic tools for the investigation of the small bowel led to a shift in definitions from OGIB to mid-gastrointestinal bleeding or small bowel bleeding [3], reserving OGIB for situations in which the bleeding source was not identified after assessment of the full length of the gastrointestinal tract [4]
Enteroscopy, and device-assisted enteroscopy (DAE), plays a significant role both in the diagnosis and in the treatment of patients presenting with OGIB

Summary

Introduction

Obscure gastrointestinal bleeding (OGIB) comprises gastrointestinal bleeding without evident etiology after the performance of conventional esophagogastroduodenoscopy (EGD) and colonoscopy. It accounts for approximately 5% of all gastrointestinal hemorrhages and represents the most common indication for the performance of device-assisted enteroscopy (DAE) [1,2]. The source of bleeding is located in the small bowel, in areas beyond the reach of conventional EGD and colonoscopy (i.e., between the second duodenal portion and distal ileum). A meta-analysis estimated a diagnostic yield of approximately 56% for double-balloon enteroscopy (DBE) in the setting of small bowel bleeding [5]

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