Endoscopy 2021; 53(12): 1199-1207
DOI: 10.1055/a-1350-5583
Original article

Evaluation of the effects of an artificial intelligence system on endoscopy quality and preliminary testing of its performance in detecting early gastric cancer: a randomized controlled trial

Lianlian Wu*
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Xinqi He*
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Mei Liu
 4  Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
,
Huaping Xie
 4  Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
,
Ping An
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Jun Zhang
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Heng Zhang
 5  Department of Gastroenterology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
,
Yaowei Ai
 6  Department of Gastroenterology, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
,
Qiaoyun Tong
 7  Department of Gastroenterology, Yichang Central People’s Hospital, China Three Gorges University, Yichang, China
,
Mingwen Guo
 6  Department of Gastroenterology, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
,
Manling Huang
 5  Department of Gastroenterology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
,
Cunjin Ge
 7  Department of Gastroenterology, Yichang Central People’s Hospital, China Three Gorges University, Yichang, China
,
Zhi Yang
 7  Department of Gastroenterology, Yichang Central People’s Hospital, China Three Gorges University, Yichang, China
,
Jingping Yuan
 8  Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
,
Jun Liu
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Wei Zhou
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Xiaoda Jiang
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Xu Huang
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Ganggang Mu
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Xinyue Wan
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Yanxia Li
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Hongguang Wang
 9  Department of Gastroenterology, Jilin People’s Hospital, Jilin, China
,
Yonggui Wang
10  School of Geography and Information Engineering, China University of Geosciences, Wuhan, China
,
Hongfeng Zhang
11  Department of Pathology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
,
Di Chen
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Dexin Gong
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Jing Wang
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Li Huang
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Jia Li
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Liwen Yao
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Yijie Zhu
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
,
Honggang Yu
 1  Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
 2  Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
 3  Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
› Author Affiliations
Supported by: Project of Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision 2018BCC337
Supported by: Hubei Province Major Science and Technology Innovation Project 2018–916–000–008

Trial Registration: Chinese Clinical Trial Registry Registration number (trial ID): ChiCTR1800018403 Type of study: Randomized, Multi-Center Study

Abstract

Background Esophagogastroduodenoscopy (EGD) is a prerequisite for detecting upper gastrointestinal lesions especially early gastric cancer (EGC). An artificial intelligence system has been shown to monitor blind spots during EGD. In this study, we updated the system (ENDOANGEL), verified its effectiveness in improving endoscopy quality, and pretested its performance in detecting EGC in a multicenter randomized controlled trial.

Methods ENDOANGEL was developed using deep convolutional neural networks and deep reinforcement learning. Patients undergoing EGD in five hospitals were randomly assigned to the ENDOANGEL-assisted group or to a control group without use of ENDOANGEL. The primary outcome was the number of blind spots. Secondary outcomes included performance of ENDOANGEL in predicting EGC in a clinical setting.

Results 1050 patients were randomized, and 498 and 504 patients in the ENDOANGEL and control groups, respectively, were analyzed. Compared with the control group, the ENDOANGEL group had fewer blind spots (mean 5.38 [standard deviation (SD) 4.32] vs. 9.82 [SD 4.98]; P < 0.001) and longer inspection time (5.40 [SD 3.82] vs. 4.38 [SD 3.91] minutes; P < 0.001). In the ENDOANGEL group, 196 gastric lesions with pathological results were identified. ENDOANGEL correctly predicted all three EGCs (one mucosal carcinoma and two high grade neoplasias) and two advanced gastric cancers, with a per-lesion accuracy of 84.7 %, sensitivity of 100 %, and specificity of 84.3 % for detecting gastric cancer.

Conclusions In this multicenter study, ENDOANGEL was an effective and robust system to improve the quality of EGD and has the potential to detect EGC in real time.

* These authors contribute equally to this work.


Supplementary material



Publication History

Received: 21 September 2020

Accepted after revision: 11 January 2021

Publication Date:
11 January 2021 (online)

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