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(IIDEAS) INTELLIGENT-C ENDOSCOPY MODULE FOR REAL-TIME DETECTION OF COLONIC LESIONS - A PROSPECTIVE, NON - RANDOMIZED, SINGLE-CENTRE STUDY (NCT 05784935)

Hardik Rughwani 1, Subhankar Godbole 1, Rajendra Patel 1, Nitin Jagtap 1, Sana Fathima Memon 1, D. Nageshwar Reddy 1, Biji Sreedhar 2, Chung Kwong Yeung 3

Affiliations

1 AIG Hospitals, Hyderabad, India

2 iIDEAS Group and iEMIS (HK), Hongkong, Hong Kong

3 The University of Hongkong, Hongkong, Hong Kong

Summary

AI Generated

A prospective single-center study evaluated a real-time AI model for colorectal polyp detection during 200 colonoscopies, finding that the AI detected all 81 lesions while endoscopists missed 20 lesions (24.7% miss rate).

In 200 colonoscopies performed in March 2023, 81 lesions were detected and removed from 42 subjects, with the AI system identifying 100% of lesions compared to 75.3% detected by endoscopists.
Endoscopists missed 20 of 81 lesions, including 4 of 27 neoplastic lesions (14.8% miss rate) and 15 of 49 non-neoplastic lesions (30.6% miss rate).
The transverse colon had the highest miss rate, with 5 of 20 missed lesions (38.5% of all missed lesions) located in this section.
Power analysis estimated the AI system's sensitivity at above 95% with an alpha of 0.05 and power of 80%.
The authors conclude that computer-aided diagnostic systems appear to perform better than endoscopy alone for polyp detection and may be useful in community practice.

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Abstract

Introduction

An accurate optical diagnosis ^1,2 of colorectal polyps could make colonoscopy more cost-effective and reduce the risks of polypectomy. In a few recent retrospective studies, it was shown that artificial intelligence (AI) could be used to find and classify colorectal polyps. Many of these studies were based on still endoscopic images or video recordings rather than their application in real-time colonoscopy procedures. We conducted an open-label, non-randomized, prospective, single-center study with the aim to validate the performance of a novel state-of-the-art Artificial Intelligence (AI) model for colorectal lesion detection during routine diagnostic colonoscopy and evaluate its feasibility in daily endoscopy.

Aims & Methods

The study is a prospective, non-randomized, single-center clinical evaluation of the real-time performance of the deep learning AI model for colorectal lesion detection in colonoscopy procedures. Under white light and NBI, the primary endoscopist did the colonoscopies with high-definition endoscopes (EVIS-EXERA 290 video system, Olympus Optical, Tokyo, Japan). All of the polyps were marked for size (measured with biopsy forceps), location, and shape based on the Paris classification, and then they were either removed or a biopsy sample was taken for histologic analysis. (Fig. 1). The main goal of this study was to figure out the "adenoma miss rate," which is the number of patients whose adenomas were missed by the endoscopists but found by the AI and then confirmed by the endoscopists on re-examination (and, as a gold standard, by histological examination). The mean and the total number of missed lesions were analyzed.

Results

Totally, 81 lesions were detected and removed from the 42 subjects, out of the n=200 colonoscopies done in March 2023. Of the 81 lesions removed from subjects, 78 (96.3%) lesions were examined, including 27 (33.3%) neoplastic lesions and 47 (60.5%) non-neoplastic lesions, and the other 3 (3.7%) lesions were not examined after snaring. As for finding lesions, the AI module found 81 of them (100%), while endoscopists found 61 of them (75.3%). Of the 20 lesions missed by the endoscopists, 5 (38.5%) were missed in the transverse colon, which was the section with the highest missing rate. Based on final histology, there were 4 (14.8%) missed neoplastic lesions and 15 (30.6%) missed non-neoplastic lesions. One missed lesion was not examined. An AI-based detection system found all the lesions. According to the power analysis, the estimated sensitivity was above 95% (with an alpha value of 0.05 and a power of 80%).

Table: Pathology distribution of colonic lesions with the missing rate of each class

Pathology	All Lesions	Lesions Missed by Endoscopist	Missing Rate
Neoplastic	27	4	14.8%
Non-Neoplastic	49	15	30.6%
Not Available	5	1	20.0%
Total	81	20	24.7%

Conclusion

Optical diagnosis using computer-aided diagnostic systems has a potential role in predicting the presence of polyps. The diagnostic performance of CAD seems to be better than that of endoscopy for colon polyp detection. With recent breakthroughs in artificial intelligence, interest in CAD is gaining traction as a novel approach to improving the quality of colonoscopies. We anticipate that each of these hurdles will likely be overcome during the next several years, which will open the door to the clinical application of CAD in colonoscopy. Large-scale use of this technology can be useful in community practice and service.

References

1. Katrevula A, Katukuri GR, Singh AP, Inavolu P, Rughwani H, Alla SR, Ramchandani M, Duvvur NR. Real-World Experience of AI-Assisted Endocytoscopy Using EndoBRAIN—An Observational Study from a Tertiary Care Center. Journal of Digestive Endoscopy. 2022 Dec 23.
2. Kudo SE, Misawa M, Mori Y, et al. Artificial intelligence-assisted system improves endoscopic identification of colorectal neoplasms. Clin Gastroenterol Hepatol 2020;18(08):1874–1881.e2

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

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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

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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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Samuel Huber

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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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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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Introduction: Dilemmas in ulcerative colitis: Back to the basics or fast forward

Peter Bossuyt 1

Affiliations

1 Imelda General Hospital, Bonheiden, Belgium

Summary

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Mechanisms & Personalised Medicine IBD

Session

Dilemmas in ulcerative colitis: Back to the basics or fast forward

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

Summary

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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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