Knowledge, perceptions and behaviours of endoscopists towards the use of artificial intelligence-aided colonoscopy.

BACKGROUND: Recent developments in artificial intelligence (AI) systems have enabled advancements in endoscopy. Deep learning systems, using convolutional neural networks, have allowed for real-time AI-aided detection of polyps with higher sensitivity than the average endoscopist. However, not all endoscopists welcome the advent of AI systems. METHODS: We conducted a survey on the knowledge of AI, perceptions of AI in medicine, and behaviours regarding use of AI-aided colonoscopy, in a single centre 2 months after the implementation of Medtronic's GI Genius in colonoscopy. We obtained a response rate of 66.7% (16/24) amongst consultant-grade endoscopists. Fisher's exact test was used to calculate the significance of correlations. RESULTS: Knowledge of AI varied widely amongst endoscopists. Most endoscopists were optimistic about AI's capabilities in performing objective administrative and clinical tasks, but reserved about AI providing personalised, empathetic care. 68.8% (n = 11) of endoscopists agreed or strongly agreed that GI Genius should be used as an adjunct in colonoscopy. In analysing the 31.3% (n = 5) of endoscopists who disagreed or were ambivalent about its use, there was no significant correlation with their knowledge or perceptions of AI, but a significant number did not enjoy using the programme (p-value = 0.0128) and did not think it improved the quality of colonoscopy (p-value = 0.033). CONCLUSIONS: Acceptance of AI-aided colonoscopy systems is more related to the endoscopist's experience with using the programme, rather than general knowledge or perceptions towards AI. Uptake of such systems will rely greatly on how the device is delivered to the end user.

One-year review of real-time artificial intelligence (AI)-aided endoscopy performance.

BACKGROUND: Colonoscopies have long been the gold standard for detection of pre-malignant neoplastic lesions of the colon. Our previous study tried real-time artificial intelligence (AI)-aided colonoscopy over a three-month period and found significant improvements in collective and individual endoscopist's adenoma detection rates compared to baseline. As an expansion, this study evaluates the 1-year performance of AI-aided colonoscopy in the same institution. METHODS: A prospective cohort study was conducted in a single institution in Singapore. The AI software used was GI Genius™ Intelligent Endoscopy Module, US-DG-2000309 © 2021 Medtronic. Between July 2021 and June 2022, polypectomy rates in non-AI-aided colonoscopies and AI-aided colonoscopies were calculated and compared. Some of the AI-aided colonoscopies were recorded and video reviewed. A "hit" was defined as a sustained detection of an area by the AI. If a polypectomy was performed for a "hit," its histology was reviewed. Additional calculations for polyp detection rate (PDR), adenoma detection rate (ADR), and adenoma detection per colonoscopy (ADPC) were performed. Cost analysis was performed to determine cost effectiveness of subscription to the AI program. RESULTS: 2433 AI-aided colonoscopies were performed between July 2021 and June 2022 and compared against 1770 non-AI-aided colonoscopies. AI-aided colonoscopies yielded significantly higher rates of polypectomies (33.6%) as compared with non-AI-aided colonoscopies (28.4%) (p < 0.001). Among the AI-aided colonoscopies, 1050 were reviewed and a final 843 were included for additional analysis. The polypectomy to "hit" ratio was 57.4%, PDR = 45.6%, ADR = 32.4%, and ADPC = 2.08. Histological review showed that 25 polyps (3.13%) were sessile-serrated adenomas. Cost analysis found that the increased polypectomy rates in AI-aided colonoscopes led to an increase in revenue, which covered the subscription cost with an excess of USD 20,000. CONCLUSION: AI-aided colonoscopy is a cost effective means of improving colonoscopy quality and may help advance colorectal cancer screening in Singapore.

The imitation game: a review of the use of artificial intelligence in colonoscopy, and endoscopists' perceptions thereof.

The development of deep learning systems in artificial intelligence (AI) has enabled advances in endoscopy, and AI-aided colonoscopy has recently been ushered into clinical practice as a clinical decision-support tool. This has enabled real-time AI-aided detection of polyps with a higher sensitivity than the average endoscopist, and evidence to support its use has been promising thus far. This review article provides a summary of currently published data relating to AI-aided colonoscopy, discusses current clinical applications, and introduces ongoing research directions. We also explore endoscopists' perceptions and attitudes toward the use of this technology, and discuss factors influencing its uptake in clinical practice.

Real-time artificial intelligence (AI)-aided endoscopy improves adenoma detection rates even in experienced endoscopists: a cohort study in Singapore.

BACKGROUND: Colonoscopy is a mainstay to detect premalignant neoplastic lesions in the colon. Real-time Artificial Intelligence (AI)-aided colonoscopy purportedly improves the polyp detection rate, especially for small flat lesions. The aim of this study is to evaluate the performance of real-time AI-aided colonoscopy in the detection of colonic polyps. METHODS: A prospective single institution cohort study was conducted in Singapore. All real-time AI-aided colonoscopies, regardless of indication, performed by specialist-grade endoscopists were anonymously recorded from July to September 2021 and reviewed by 2 independent authors (FHK, JL). Sustained detection of an area by the program was regarded as a "hit". Histology for the polypectomies were reviewed to determine adenoma detection rate (ADR). Individual endoscopist's performance with AI were compared against their baseline performance without AI endoscopy. RESULTS: A total of 24 (82.8%) endoscopists participated with 18 (62.1%) performing ≥ 5 AI-aided colonoscopies. Of the 18, 72.2% (n = 13) were general surgeons. During that 3-months period, 487 "hits" encountered in 298 colonoscopies. Polypectomies were performed for 51.3% and 68.4% of these polypectomies were adenomas on histology. The post-intervention median ADR was 30.4% was higher than the median baseline polypectomy rate of 24.3% (p = 0.02). Of the adenomas excised, 14 (5.6%) were sessile serrated adenomas. Of those who performed ≥ 5 AI-aided colonoscopies, 13 (72.2%) had an improvement of ADR compared to their polypectomy rate before the introduction of AI, of which 2 of them had significant improvement. CONCLUSIONS: Real-time AI-aided colonoscopy have the potential to improved ADR even for experienced endoscopists and would therefore, improve the quality of colonoscopy.

Rate of Recurrent Luminal Esophageal Cancer in Asymptomatic Patients After Curative Treatment for Esophageal Cancer.

GOALS: The goal of this study was to determine the luminal recurrence rate of asymptomatic patients undergoing annual surveillance esophagogastroduodenoscopy (EGD). BACKGROUND: Current guidelines recommend surveillance EGD in postesophagectomy patients with esophageal cancer if there is clinical suspicion of local recurrence. However, many patients undergo annual surveillance EGD despite the recommendations to the contrary. STUDY: A query was performed of all patients who underwent esophagectomy between January 2000 and April 2010 at Moffitt Cancer Center. Patients were included if: they underwent esophagectomy with curative intent, had at least 12 months of follow-up after surgery, and had a R0 resection. Clinical and pathologic data in patients with and without recurrent disease were compared using the Fisher exact tests. Mean differences were examined using the Wilcoxon rank sum test. RESULTS: 346 patients were included with a mean age of 63.5±10.4 years and mean follow-up of 40.9±24.8 months. Recurrence was detected in 89 (25.7%) patients at a mean follow-up of 17.9±15.9 months after surgery. Seventeen (19.1%) patients had recurrence involving the esophagus but 7 (7.9%) patients had associated regional or distant metastases. Nine patients had abnormal signs/symptoms prompting evaluation with EGD. One patient had isolated luminal recurrence. CONCLUSIONS: In this study the majority of patients recurred in the metastatic setting. One (0.29%) patient had localized recurrence; however, it was unclear if this patient had any symptoms or signs to prompt evaluation. Our results support the current recommendation of a symptom-base endoscopic evaluation for esophageal cancer recurrence.

Predictors of gastroesophageal reflux symptoms in pregnant women screened for sleep disordered breathing: a secondary analysis.

BACKGROUND: Gastroesophageal reflux disease (GERD) is common in pregnancy. The cause is multifactorial, including a decreased or transient lower esophageal sphincter relaxation, increased intra-abdominal pressure, and gastrointestinal motility disturbances. AIMS: Evaluate the incidence of GERD in pregnancy and assess predictors and predisposing factors. METHOD: This is a secondary analysis of a survey of postpartum women regarding symptoms of sleep disordered breathing (SDB) and GERD performed at a large tertiary care center. Patients rated heartburn frequency during pregnancy as either never, occasionally/sometimes, or frequently/always. Pregnancy outcomes and newborn information was collected. Categorical variables were compared by Fisher's exact test and continuous variables were compared by Anova or Kruskal-Wallis test. Multinominal logistic regression was also performed. RESULTS: Information regarding 1000 mothers and 1025 newborns was reviewed. The majority of mothers were Caucasian (68.8%) with mean age 29 ± 6.1 years. A total of 56.7% had GERD frequently/always; and 25.5% had none. GERD symptoms correlated with pre-pregnancy body mass index (BMI), BMI at delivery, maternal age, smoking and symptoms of SDB. There was no significant correlation between fetal weight and maternal weight gain with GERD symptoms. Symptoms were more frequent in white non-Hispanic women than in other racial groups. CONCLUSIONS: This study suggests that GERD symptoms correlate with pre-pregnancy BMI and BMI at delivery, but not with the amount of weight gain during pregnancy. Maternal age, smoking, race, and SDB are also associated with GERD. Interestingly, fetal weight/uterine size did not seem predictive of developing GERD in pregnancy.

Current state of endoscopic therapies in Barrett's esophagus and esophageal cancer.

Barrett's esophagus (BE) is a premalignant condition that predisposes patients to esophageal adenocarcinoma. This risk increases with increasing dysplasia, especially in patients with BE and high-grade dysplasia. Radical esophagectomy had long been the only option for these patients; however, it has been associated with significant morbidity and mortality. Endoscopic therapies have been increasingly used as an alternative to radical esophagectomy given the minimally invasive nature and tolerability of the procedure relative to surgery. Currently, the most widely used endoscopic therapies include endoscopic mucosal resection, photodynamic therapy, CryoSpray ablation, and radiofrequency ablation. Retrospective and prospective studies on the use of each of these modalities in patients with nondysplastic BE, dysplastic BE, and early esophageal cancer have demonstrated their effectiveness in eradication of dysplasia with or without reversion of Barrett's epithelium to normal squamous epithelium of the esophagus. These modalities are well tolerated, safe, and have few side effects. Ultimately, more research is needed regarding their ability to fully displace surgical intervention as the gold standard, although at this point their role in poor operative candidates or patients seeking conservative approaches remains promising.

Kaposi's sarcoma-associated herpesvirus lytic origin (ori-Lyt)-dependent DNA replication: identification of the ori-Lyt and association of K8 bZip protein with the origin.

Herpesviruses utilize different origins of replication during lytic versus latent infection. Latent DNA replication depends on host cellular DNA replication machinery, whereas lytic cycle DNA replication requires virally encoded replication proteins. In lytic DNA replication, the lytic origin (ori-Lyt) is bound by a virus-specified origin binding protein (OBP) that recruits the core replication machinery. In this report, we demonstrated that DNA sequences in two noncoding regions of the Kaposi's sarcoma-associated herpesvirus (KSHV) genome, between open reading frames (ORFs) K4.2 and K5 and between K12 and ORF71, are able to serve as origins for lytic cycle-specific DNA replication. The two ori-Lyt domains share an almost identical 1,153-bp sequence and a 600-bp downstream GC-rich repeat sequence, and the 1.7-kb DNA sequences are sufficient to act as a cis signal for replication. We also showed that an AT-palindromic sequence in the ori-Lyt domain is essential for the DNA replication. In addition, a virally encoded bZip protein, namely K8, was found to bind to a DNA sequence within the ori-Lyt by using a DNA binding site selection assay. The binding of K8 to this region was confirmed in cells by using a chromatin immunoprecipitation method. Further analysis revealed that K8 binds to an extended region, and the entire region is 100% conserved between two KSHV ori-Lyt's. K8 protein displays significant similarity to the Zta protein of Epstein-Barr virus (EBV), which is a known OBP of EBV. This notion, together with the ability of K8 to bind to the KSHV ori-Lyt, suggests that K8 may function as an OBP in KSHV.