Open Access

Shannon Melissa Chan, Daniel Chan, Hon Chi Yip, Markus Wolfgang Scheppach, Ray Lam, Stephen K. K. Ng, Enders Kwok Wai Ng, Philip W. Chiu

• Background and study aims Completeness of esophagagogastroduodenoscopy (EGD) varies among endoscopists, leading to a high miss rate for gastric neoplasms. This study aimed to determine the effect of the Cerebro real-time artificial intelligence (AI) system on completeness of EGD for endoscopists in early stages of training. Patients and methods The AI system was built with CNN and Motion Adaptive Temporal Feature Aggregation (MA-TFA). A prospective sequential cohort study was conducted. Endoscopists were taught about the standardized EGD protocol to examine 27 sites. Then, each subject performed diagnostic EGDs per protocol (control arm). After completion of the required sample size, subjects performed diagnostic EGDs with assistance of the AI (study arm). The primary outcome was the rate of completeness of EGD. Secondary outcomes included overall inspection time, individual site inspection time, completeness of photodocumentation, and rate of positive pathologies. ResultsBackground and study aims Completeness of esophagagogastroduodenoscopy (EGD) varies among endoscopists, leading to a high miss rate for gastric neoplasms. This study aimed to determine the effect of the Cerebro real-time artificial intelligence (AI) system on completeness of EGD for endoscopists in early stages of training. Patients and methods The AI system was built with CNN and Motion Adaptive Temporal Feature Aggregation (MA-TFA). A prospective sequential cohort study was conducted. Endoscopists were taught about the standardized EGD protocol to examine 27 sites. Then, each subject performed diagnostic EGDs per protocol (control arm). After completion of the required sample size, subjects performed diagnostic EGDs with assistance of the AI (study arm). The primary outcome was the rate of completeness of EGD. Secondary outcomes included overall inspection time, individual site inspection time, completeness of photodocumentation, and rate of positive pathologies. Results A total of 466 EGDs were performed with 233 in each group. Use of AI significantly improved completeness of EGD [mean (SD) (92.6% (6.2%) vs 71.2% (16.8%)]; P <0.001 (95% confidence interval 19.2%–23.8%, SD 0.012). There was no difference in overall mean (SD) inspection time [765.5 (338.4) seconds vs 740.4 (266.2); P=0.374]. Mean (SD) number of photos for photo-documentation significantly increased in the AI group [26.9 (0.4) vs 10.3 (4.4); P <0.001]. There was no difference in detection rates for pathologies in the two groups [8/233 (3.43%) vs 5/233 (2.16%), P=0.399]. Conclusions Completeness of EGD examination and photodocumentation by endoscopists in early stages of are improved by the AI-assisted software Cerebro.…