Clinical Endoscopy

Performance comparison between two computer-aided detection colonoscopy models by trainees using different false positive thresholds: a cross-sectional study in Thailand: Kasenee Tiankanon, Julalak Karuehardsuwan, Satimai Aniwan, Parit Mekaroonkamol, Panukorn Sunthornwechapong, Huttakan Navadurong, Kittithat Tantitanawat, Krittaya Mekritthikrai, Salin Samutrangsi, Peerapon Vateekul, Rungsun Rerknimitr; Clin Endosc 2024;57(2):217-225. Published online February 7, 2024; DOI: https://doi.org/10.5946/ce.2023.145

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Background
/Aims: This study aims to compare polyp detection performance of “Deep-GI,” a newly developed artificial intelligence (AI) model, to a previously validated AI model computer-aided polyp detection (CADe) using various false positive (FP) thresholds and determining the best threshold for each model.
Methods
Colonoscopy videos were collected prospectively and reviewed by three expert endoscopists (gold standard), trainees, CADe (CAD EYE; Fujifilm Corp.), and Deep-GI. Polyp detection sensitivity (PDS), polyp miss rates (PMR), and false-positive alarm rates (FPR) were compared among the three groups using different FP thresholds for the duration of bounding boxes appearing on the screen.
Results
In total, 170 colonoscopy videos were used in this study. Deep-GI showed the highest PDS (99.4% vs. 85.4% vs. 66.7%, p<0.01) and the lowest PMR (0.6% vs. 14.6% vs. 33.3%, p<0.01) when compared to CADe and trainees, respectively. Compared to CADe, Deep-GI demonstrated lower FPR at FP thresholds of ≥0.5 (12.1 vs. 22.4) and ≥1 second (4.4 vs. 6.8) (both p<0.05). However, when the threshold was raised to ≥1.5 seconds, the FPR became comparable (2 vs. 2.4, p=0.3), while the PMR increased from 2% to 10%.
Conclusions
Compared to CADe, Deep-GI demonstrated a higher PDS with significantly lower FPR at ≥0.5- and ≥1-second thresholds. At the ≥1.5-second threshold, both systems showed comparable FPR with increased PMR.

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Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea
Jung-Bin Park, Jung Ho Bae
Clinical Endoscopy.2025; 58(1): 112. CrossRef
Understanding the discrepancy in the effectiveness of artificial intelligence-assisted colonoscopy: from randomized controlled trials to clinical reality
Jung Ho Bae
Clinical Endoscopy.2024; 57(6): 765. CrossRef
Edge Artificial Intelligence Device in Real-Time Endoscopy for Classification of Gastric Neoplasms: Development and Validation Study
Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
Biomimetics.2024; 9(12): 783. CrossRef

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Perception of Gastrointestinal Endoscopy Personnel on Society Recommendations on Personal Protective Equipment, Case Selection, and Scope Cleaning During Covid-19 Pandemic: An International Survey Study: Parit Mekaroonkamol, Kasenee Tiankanon, Rapat Pittayanon, Wiriyaporn Ridtitid, Fariha Shams, Ghias Un Nabi Tayyab, Julia Massaad, Saurabh Chawla, Stanley Khoo, Siriboon Attasaranya, Nonthalee Pausawasdi, Qiang Cai, Thawee Ratanachu-ek, Pradermchai Kongkham, Rungsun Rerknimitr; Clin Endosc 2022;55(2):215-225. Published online September 29, 2021; DOI: https://doi.org/10.5946/ce.2021.051

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: The Thai Association for Gastrointestinal Endoscopy published recommendations on safe endoscopy during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the practicality and applicability of the recommendations and the perceptions of endoscopy personnel on them.
Methods
A validated questionnaire was sent to 1290 endoscopy personnel globally. Of these, the data of all 330 responders (25.6%) from 15 countries, related to the current recommendations on proper personal protective equipment (PPE), case selection, scope cleaning, and safety perception, were analyzed. Ordinal logistic regression was used to determine the relationships between the variables.
Results
Despite an overwhelming agreement with the recommendations on PPE (94.5%) and case selection (95.5%), their practicality and applicability on PPE recommendations and case selection were significantly lower (p=0.001, p=0.047, p<0.001, and p=0.032, respectively). Factors that were associated with lower sense of safety in endoscopy units were younger age (p=0.004), less working experience (p=0.008), in-training status (p=0.04), and higher national prevalence of COVID-19 (p=0.003). High prevalent countries also had more difficulty implementing the guidelines (p<0.001) and they considered the PPE recommendations less practical and showed lower agreement with them (p<0.001 and p=0.008, respectively). A higher number of in-hospital COVID-19 patients was associated with less agreement with PPE recommendations (p=0.039).
Conclusions
Using appropriate PPE and case selection in endoscopic practice during a pandemic remains a challenge. Resource availability and local prevalence are critical factors influencing the adoption of the current guidelines.

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Practice Patterns and Use of Endoscopic Retrograde Cholangiopancreatography in the Management of Recurrent Acute Pancreatitis: Jonathan B. Reichstein, Vaishali Patel, Parit Mekaroonkamol, Sunil Dacha, Steven A. Keilin, Qiang Cai, Field F. Willingham; Clin Endosc 2020;53(1):73-81. Published online July 5, 2019; DOI: https://doi.org/10.5946/ce.2019.052

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Background
/Aims: There are conflicting opinions regarding the management of recurrent acute pancreatitis (RAP). While some physicians recommend endoscopic retrograde cholangiopancreatography (ERCP) in this setting, others consider it to be contraindicated in patients with RAP. The aim of this study was to assess the practice patterns and clinical features influencing the management of RAP in the US.
Methods
An anonymous 35-question survey instrument was developed and refined through multiple iterations, and its use was approved by our Institutional Review Board. The survey was distributed via email to 408 gastroenterologists to assess the practice patterns in the management of RAP in multiple clinical scenarios.
Results
The survey was completed by 65 participants representing 36 of the top academic/tertiary care centers across the country. Approximately 90.8% of the participants indicated that they might offer or recommend ERCP in the management of RAP. Multinomial logistic regression analysis revealed that ductal dilatation and presence of symptoms were the most predictive variables (p<0.001) for offering ERCP.
Conclusions
A preponderance of the respondents would consider ERCP among patients with RAP presenting to tertiary care centers in the US. Ductal dilatation, presence of symptoms, and pancreas divisum significantly increased the likelihood of a recommendation for ERCP

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Controversies in ERCP
Christoph F. Dietrich, Noor L. Bekkali, Sean Burmeister, Yi Dong, Simon M. Everett, Michael Hocke, Andre Ignee, Wei On, Srisha Hebbar, Kofi Oppong, Siyu Sun, Christian Jenssen, Barbara Braden
Endoscopic Ultrasound.2022; 11(1): 27. CrossRef
Controversies in ERCP
Christoph F. Dietrich, Noor L. Bekkali, Sean Burmeister, Yi Dong, Simon M. Everett, Michael Hocke, Andre Ignee, Wei On, Srisha Hebbar, Kofi Oppong, Siyu Sun, Christian Jenssen, Barbara Braden
Endoscopic Ultrasound.2022; 11(3): 186. CrossRef
Biliary hitch and ride technique for blind pancreatic duct cannulation
Juan J. Vila, Juan Carrascosa, Ignacio Fernández-Urién, Paul Yeaton, Gonzalo González, Leire Aburruza, José Manuel Zozaya
Endoscopy.2021; 53(01): E29. CrossRef
Endoscopic Retrograde Cholangiopancreatography in Recurrent Acute Pancreatitis: Determining the Optimal Subgroup of Patients in Whom the Procedure is Beneficial
Tae Yoon Lee, Takuji Iwashita
Clinical Endoscopy.2020; 53(1): 5. CrossRef

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Long -Term Survival in Stage IV Esophageal Adenocarcinoma with Chemoradiation and Serial Endoscopic Cryoablation: Zachary Spiritos, Parit Mekaroonkamol, Bassel F. El- Rayes, Seth D. Force, Steven A. Keilin, Qiang Cai, Field F. Willingham; Clin Endosc 2017;50(5):491-494. Published online April 24, 2017; DOI: https://doi.org/10.5946/ce.2017.006

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Esophageal cancer has a poor overall prognosis and is frequently diagnosed at a late stage. Conventional treatment for metastatic esophageal cancer involves chemotherapy and radiation. Local disease control plays a significant role in improving survival. Endoscopic spray cryotherapy is a novel modality that involves freezing and thawing to produce local ablation of malignant tissue via ischemic mechanisms. Spray cryotherapy has been shown to be effective, particularly for early T-stage, superficial esophageal adenocarcinomas. We present the case of a 72-year-old-male with locally recurrent stage IV esophageal adenocarcinoma and long-term survival of 7 years to date, with concurrent chemoradiation and serial cryoablation. He remains asymptomatic and continues to undergo chemotherapy and sequential cryoablation. The findings highlight the long-term safety and efficacy of cryotherapy in combination with chemoradiation, and suggest that cryoablation may have an additive role in the treatment of advanced stage esophageal adenocarcinoma.

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Endoscopic Palliative Therapies for Esophageal Cancer
Youssef Y. Soliman, Madappa Kundranda, Toufic Kachaamy
Gastrointestinal Endoscopy Clinics of North America.2024; 34(1): 91. CrossRef
Role of oesophageal balloon cryoablation in combination with personalised immunotherapy to achieve luminal control in metastatic oesophageal cancer: a case report
Benjamin Charles Norton, Apostolis Papaefthymiou, Andrea Telese, Margaret Duku, Imran Chaudhry, Alberto Murino, Gavin Johnson, Charles Murray, Rehan Haidry
Frontline Gastroenterology.2024; 15(4): 336. CrossRef
Cryoballoon ablation as salvage therapy after nonradical resection of a high-risk T1b esophageal adenocarcinoma: a case report
Charlotte N. Frederiks, Jolanda M.W. van de Water, Gati Ebrahimi, Bas L.A.M. Weusten
European Journal of Gastroenterology & Hepatology.2022; 34(3): 354. CrossRef
Surgery to the primary tumor is associated with improved survival of patients with metastatic esophageal cancer: propensity score-matched analyses of a large retrospective cohort
Rui Zhang, Jiahua Zou, Ping Li, Qin Li, Yunfeng Qiao, Jianglong Han, Kejie Huang, Peng Ruan, Huiqing Lin, Qibin Song, Zhenming Fu
Diseases of the Esophagus.2019;[Epub] CrossRef

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