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A PROOF CONCEPT STUDY OF NAVIGATION SYSTEM USING ARTIFICIAL INTELLIGENCE FOR COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Takemasa Hayashi 1, Shinei Kudo 1, Tatsuya Sakurai 1, Masahiro Abe 1, Yuta Sato 1, Yuta Kouyama 1, Yushi Ogawa 1, Yasuharu Maeda 1, Hiroki Nakamura 1, Masashi Misawa 1, Kunihiko Wakamura 1, Hideyuki Miyachi 1, Toshiyuki Baba 1

Affiliations

1 Showa University Northern Yokohama Hospital, Yokohama, Japan

Summary

AI Generated

A proof of concept study demonstrates that deep learning using U-NET semantic segmentation can identify submucosal and muscular layers in colorectal endoscopic submucosal dissection procedure images with 83.0% pixel-level accuracy.

The study trained an AI model on 1,561 images from 9 colorectal ESD procedures and validated it on 90 images from 1 separate case, using 16 different pixel-level labels including mucosa, submucosa, muscular layer, and blood vessels.
The trained AI achieved 83.0% accuracy in correctly identifying labeled pixels, with relatively better discrimination of submucosa, muscular layers, and vessels which had larger labeled areas.
The study population included 11 cases with mean age 71.9 years, mean tumor diameter 25.2 mm, colon to rectum ratio 8:2, and adenoma to T1 cancer ratio 5:6.
The authors conclude that segmentation technology demonstrates feasibility of real-time AI-assisted ESD navigation and plan to improve the system by increasing training images.
This work addresses the clinical challenge that accurate identification of blood vessels and muscle layers is essential for safe colorectal ESD but difficult when monitoring all image information during the procedure.

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Abstract

Introduction

Colorectal endoscopic submucosal dissection (ESD) is an effective treatment for large colorectal tumors, but the technique is more difficult and is associated with more complications such as bleeding and perforation compared to EMR. Therefore, accurate identification of blood vessels and muscle layers is essential for safe colorectal ESD. However, it is often difficult to perform the treatment while recognizing all of the image information on the monitor. Therefore, in this study, we conducted a proof of concept study to determine whether deep learning can be used to identify the submucosa and muscular layer in images taken during ESD procedures.

Aims & Methods

We used 11 procedure videos randomly selected from cases of colorectal ESD performed at our center between January 2020 and July 2022. The videos were cropped every second as still images, and these still images were labeled with semantic segmentation (hereafter referred to as segmentation). This is a method of labeling each pixel in an image, and Artificial intelligence (AI) trained with this method can segment regions of the target image according to the tissues and devices depicted in the image.
In this study, 16 different labels were performed for each pixel of each image, including mucosa, submucosa, muscular layer, and blood vessels. Of the 11 labeled case images, 9 cases were used for training and 1 case with no duplicate training was used for validation. The training images were machine learned with a representative method of medical image segmentation called U-NET and evaluated for accuracy.

Results

Characteristics of patients and tumors of the 11 cases in this study were male to female ratio of 7:4, mean age of 71.9 years (36-83), mean tumor diameter 25.2 mm (3-54 mm), colon/rectum ratio of 8:2, adenoma to T1 cancer ratio 5:6. One thousand and five hundreds sixty-one images were used for training, and 90 images were used for evaluation as validation. The accuracy (corresponding to the number of pixels correctly answered out of the labeled pixels) of the trained AI to the validation images was 83.0%. The submucosa, muscular layers, and vessels, which have a large labeled area, were relatively discriminated.

Conclusion

The use of segmentation technology demonstrated the feasibility of real-time ESD navigation by AI. In the near future, we aim to further improve the system by increasing the number of training images.

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Is an RCT still the holy grail?

Gionata Fiorino 1

Affiliations

1 IRCCS Humanitas, Milan, Italy

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

IBD

Session

What can we learn from ‘failed’ IBD trials?

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Samuel Huber

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MICROBIOTA-DRIVEN LONGITUDINAL REGULATION OF INTESTINAL CD4+ T CELL PLASTICITY IN HUMAN AND MURINE INFLAMMATORY BOWEL DISEASE

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MICROBIOTA-DRIVEN LONGITUDINAL REGULATION OF INTESTINAL CD4+ T CELL PLASTICITY IN HUMAN AND MURINE INFLAMMATORY BOWEL DISEASE

Andres Machicote 1,2, Beibei Liu 1,2, Marie Wende 3, Franziska Stallbaum 1,2, Babett Steglich 1,2, Ban H. Tran 1,2, Sandra Wende 1,2, Saskia Großhauser 1,2, Zehra Oguz-Cöloglu 1, Till Robin Lesker 3, Moritz von Wulffen 1, Penelope Pelczar 2,1, Tanja Bedke 1,2, Mikolaj Nawrocki 1,2, Marius Böttcher 1, Jan Kempski 1, Katharina Moll 1, Thorben W. Fründt 1, Thomas Rösch 1, Till Strowig 3, Nicola Gagliani 4,2, Samuel Huber 1,2

Affiliations

1 Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany

2 Hamburg Center for Translational Immunology, Hamburg, Germany

3 Helmholtz-Zentrum für Infektionsforschung, Braunschweig, Germany

4 Institute for Inflammation and Carcinogenesis, Hamburg, Germany

Summary

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Abstract

Introduction

Intestinal CD4+ T cells closely interact with the microbiota. In inflammatory bowel disease (IBD), microbial dysbiosis promotes the pathological activation of CD4+ T cells and thereby intestinal inflammation. Notably, a fraction of CD4+ T cells retains a degree of phenotypic plasticity, but whether this occurs locally in the intestine in established human disease is unclear. Moreover, strategies to manipulate T cell plasticity in vivo toward a regulatory phenotype remain unexplored. Here, we show that intestinal CD4+ T cells in mice and humans are plastic, and their fate is shaped by the microbial composition.

Aims & Methods

We aimed to investigate whether by targeting the intestinal microbiota we can orchestrate the in vivo conversion of pathogenic CD4+ T cells into regulatory T cells. To study human intestinal T cell plasticity, paired biopsies were longitudinally collected from healthy individuals (n=5) and patients (n=4) with >10 years of intestinal disease. Microbiota composition was altered using antibiotics. At each time point, single-cell RNA and TCR sequencing were performed on intestinal CD4+ T cells. The TCR was used as a barcode to track clones over time and compare transcriptional changes. IL-17A fate-mapping mice, an antibiotic-dependent relapsing IBD mouse model, gnotobiotic mice and conditional knockouts were used to dissect how the microbiota controls T cell plasticity and its relevance to restore tissue homeostasis.

Results

A principal coordinate analysis revealed higher transcriptional heterogeneity in CD4+ T cells from inflamed compared with healthy human intestine. In line with this, human CD4+ T cell clones from the inflamed tissue showed increased longitudinal transcriptional variability compared to clones isolated from the healthy gut. Antibiotic-induced microbial shifts strongly reduced IL-17A expression on intestinal CD4+ T cells, as shown by unsupervised analysis of differentially expressed genes. Interestingly, after antibiotic treatment we found a higher conversion of former IL-17A+ T cell clones into FOXP3+ clones. In contrast, CD4+ T cell clones in the healthy intestine were more stable over time. In mice, antibiotic treatment enhanced the conversion of IL-17A+ (Th17) cells into regulatory Foxp3+ T cells, which correlated with the expansion of beneficial bacteria. Antibiotic withdrawal reversed both the clinical phenotype and T cell plasticity, accompanied by the re-expansion of pro-inflammatory bacteria. Mechanistically, colonization of germ-free mice with the antibiotic-treated microbiota mirrored the protective effects, indicating microbiota-driven regulation of T cell plasticity. Finally, a conditional deletion of Foxp3 in Th17 cells curtailed antibiotic-induced mucosal healing, indicating a key functional role of T cell plasticity in restoring gut homeostasis.

Conclusion

Intestinal CD4+ T cell plasticity is dynamically shaped by the local environment in mice and humans, even during chronic inflammation. The microbiota is a key determinant of intestinal Th17 cell fate. Microbiota manipulation enables the in vivo modulation of T cell plasticity toward a regulatory Foxp3+ phenotype, restoring immune homeostasis. Overall, these findings identify CD4+ T cell plasticity as a potential therapeutic target in IBD.

Event

UEG Week Barcelona 2026

Topics

Gut Microbiota Mechanisms & Personalised Medicine Immunology IBD

Submission format

Abstract

Session

New insights into IBD mechanisms

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Samuel Huber

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UEG Presentation

New

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From squamous to Barrett’s: Endoscopic treatment of oesophageal neoplasia

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From squamous to Barrett’s: Endoscopic treatment of oesophageal neoplasia

Roos E. Pouw 1

Affiliations

1 Amsterdam UMC, Amsterdam, Netherlands

Summary

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Oesophagus Endoscopy Digestive Oncology

Session

Scope it out: Endoscopic mastery in upper GI neoplasia

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Samuel Huber

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Education of endoscopy nurses in Europe – 30 years and still not standardised

Ulrike Beilenhoff 1

Affiliations

1 ESGENA Scientific Secretary, Ulm, Germany

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Nurses

Session

Education of patients and staff

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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UEG Poster

Audio / Video Poster

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BEYOND THE ORDINARY: A RARE CASE OF MENETRIER’S DISEASE

Maria Kalsoom 1, Asim Shehzad 1, Hareem Fatima 2, Sadaf Noureen 3

Affiliations

1 Foundation University Medical College/Fauji Foundation Hospital, Islamabad, Pakistan

2 Advance Home Service, Islamabad, Pakistan

3 The Groves Medical Center, New Malden, London, United Kingdom

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Abstract

Clinical Case Summary

We present a rare case of protein losing gastropathy.A 60-year-old female presented to our clinic with 10 years history of intermittent dyspepsia with no alarm features and peripheral oedema for 6 months.Physical examination was unremarkable except mild bilateral pitting oedema.Pertinent investigations suggested normal albumin,urine analysis,renal&liver profiles and a normal echocardiogram.Subsequent testing with esophagogastroduodenoscopy(EGD) for dyspepsia showed hypertrophied mucosal folds predominantly in gastric corpus while sparing the antrum.Full thickness biopsies were taken and sent for histopathology with differentials of Lymphoma,adenocarcinoma,sarcoidosis and Menetrier’s disease.Stool antigen for Helicobacter Pylori(H.Pylori)thereafter,was positive while Contrast enhanced CT abdomen was consistent with mildly thickened gastric walls.Histological examination demostrated foveolar hyperplasia,elongated gastric pits and cystically dilated gastric glands without any features of malignancy.Hence a diagnosis of Menetrier’s disease(underlying H.Pylori) was made.
Patient then had H.Pylori eradication therapy as well as a diet rich in medium-chain fatty acids and proteins.H.Pylori eradication was confirmed.6 months follow up revealed partial resolution of her symptoms but no change in endoscopic findings.Patient could not undergo further treatment with biologics(cetuximab)due to financial constraints and octreotide for its local unavailability.She is now on a yearly endoscopic surveillance for future high risk of gastric malignancies.

To conclude,Menetrier's disease is not only a diagnostic dilemma for its rare occurrence,numerous differentials and need of full thickness diagnostic biopsy but also a treatment challenge.¹Menetrier’s being a progressive disease in adults,needs proper treatment as well as regular surveillance.Management remains highly controversial yet advent of new biological therapies showed promising outcomes offering potential future treatment.²

References

Fig1A.Haematoxylin & Eosin staining shows foveolar & mucous cell hyperplasia,elongated gastric pits and lymphocytic infiltration.
Fig1B.Haematoxylin & Eosin staining shows cystic dilation of gastric glands
1.Pepa P, Uehara T, Wonaga A, Redondo A, Avagnina A, Mazzocchi O, Antelo P, Waldbaum C, Sorda J. Menetrier's disease. A diagnostic and therapeutic challenge. Medicina (B Aires). 2021;81(3):470-473. English. PMID: 34137712.
2.Gore M, Bansal K, Jadhav N. Menetrier Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [updated 2023 Jun 25].

Disclosure

No conflicts

Conference

UEG Week Berlin 2025

Topics

Stomach & H. Pylori

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2025

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

The effectiveness of an extended bowel preparation regimen in capsule endoscopy

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The effectiveness of an extended bowel preparation regimen in capsule endoscopy

Joseph Garzia 1

Affiliations

1 Mater Dei Hospital, Zabbar, Malta

Summary

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Abstract

Event

UEG Week Vienna 2024

Topics

Nurses

Session

Abstracts II: Patient care and endoscopic techniques

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Samuel Huber

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Roos E. Pouw

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Joseph Garzia