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COMPUTER AIDED QUALITY CONTROL SYSTEM IMPROVES BARRETT’S NEOPLASIA DETECTION IN AN EX-VIVO SETTING

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COMPUTER AIDED QUALITY CONTROL SYSTEM IMPROVES BARRETT’S NEOPLASIA DETECTION IN AN EX-VIVO SETTING

Martijn R. Jong 1, Tim Jaspers 2, Rixta van Eijck van Heslinga 1, Jelmer Jukema 1, Carolus Kusters 2, Tim Boers 2, Roos E. Pouw 3, Lucas Duits 1, Peter H. N. de With 2, Fons van der Sommen 2, Jeroen de Groof 1, Jacques J. Bergman 1

Affiliations

1 Amsterdam UMC, Amsterdam, Netherlands

2 TU Eindhoven, Eindhoven, Netherlands

3 UMC Utrecht, Utrecht, Netherlands

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Abstract

Introduction

Early detection of neoplasia in Barrett’s Esophagus (BE) remains challenging. Although computer-aided detection (CADe) systems are increasingly available to support endoscopists, successful CADe implementation largely depends on the quality of endoscopic images, which can vary significantly in clinical practice. This study introduces an innovative computer-aided quality (CAQ) system designed for BE endoscopy, capable of assessing various image quality parameters, providing real-time feedback to the endoscopist, and operating in conjunction with an established CADe system.

Aims & Methods

The CAQ system was trained on 4,926 images from 243 BE patients to assess both objective (e.g., blurriness, illumination, and specular reflections) and subjective (i.e., mucosal cleanliness and esophageal expansion) image quality factors. The system is able to provide real-time feedback on these quality parameters to the endoscopist. Additionally, it is configured to function as a preprocessing filter for a previously developed CADe system, automatically excluding lower-quality images. To validate the CAQ system’s performance as a standalone tool, we constructed an endoscopic image quality test set, which included 647 images from 51 non-dysplastic BE patients across eight hospitals. These images were annotated for objective (e.g. motion blur, lighting) and subjective (i.e. esophageal expansion, mucosal cleanliness) image quality parameters by two experts. Additionally, to evaluate the CAQ system’s role as a preprocessing step for an established CADe system, we created the Barrett CADe test set, containing 956 frames from 62 neoplastic BE patients and 557 frames from 35 non-dysplastic BE patients from 12 Barrett referral centers. Outcome measures included agreement scores with experts for standalone image quality assessment and sensitivity, specificity, and Area-under-the-Curve (AUC) for BE neoplasia detection.

Results

As a stand-alone system, the CAQ system achieved Cohen’s Kappa scores for agreement with expert annotators of 0.73, 0.91, and 0.89 for objective image quality parameters, mucosal cleanliness, and esophageal expansion, respectively—comparable to inter-annotator scores of 0.73, 0.93, and 0.83. When used as a preprocessing filter for the CADe system, the CAQ system improved the CADe's sensitivity from 82% to 90% and the AUC from 87% to 91%, while specificity remained stable at 75% (Table 1).

Table 1. Performance of the CADe system for Barrett’s neoplasia detection with and without the CAQ system.

Evaluated by	Sensitivity, %, (95% CI)	Specificity, %, (95% CI)	AUC, %, (95% CI)
CADe	82.2 (79.7 - 84.5)	74.7 (70.9 - 78.1)	87.2 (79.9 - 94.5)
CAQ + CADe	89.9 (87.2 - 92.1)	74.7 (70.0 - 78.9)	91.4 (82.0 - 100)

Conclusion

This study introduces the first CAQ system specifically aimed at automated quality control in BE endoscopy. As a standalone tool, the system effectively distinguishes poorly from well-visualized mucosa. When combined with an established CADe system, it enhances detection rates for neoplasia, highlighting its potential to improve diagnostic accuracy in BE surveillance.

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Endoscopy Oesophagus

Submission format

Abstract

Session

From prediction to detection in upper GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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OPTIMAL TIMING OF RESUMING ANTICOAGULANTS AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

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OPTIMAL TIMING OF RESUMING ANTICOAGULANTS AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Daichi Togo 1, Naohisa Yoshida 2, Yoshikazu Hayashi 3, Kazunori Takada 4, Shiro Oka 5, Shusei Fukunaga 6, Y. Morita 7, Takemasa Hayashi 8, Kazuhiro Kozuka 9, Yosuke Tsuji 10, Takashi Murakami 11, Takeshi Yamamura 12, Yoriaki Komeda 13, Yoji Takeuchi 14, Kensuke Shinmura 15, Hiroko Fukuda 16, Shinji Yoshii 17, Shoko Ono 18, Shinichi Katsuki 19, Kazumasa Kawashima 20, Daiki Nemoto 21, Hiroyuki Yamamoto 22, Yutaka Saito 23, Naoto Tamai 24, Aya Tamura 25,26, Yuki Itoi 27, Shigetsugu Tsuji 28, Yoshikazu Inagaki 29, Yutaka Inada 30, Unknown Unknown 31, Daisuke Hasegawa 32, Takaaki Murakami 33, Unknown Unknown 34, Kohei Fukumoto 35, Takayuki Motoyoshi 36, Yasuki Nakatani 37, Yasushi Sano 38, Mikitaka Iguchi 39, Shigehiko Fujii 40, Hiromitsu Ban 41, Keita HARADA 42, Koichi Okamoto 43, Hitoshi Nishiyama 44, Fumisato Sasaki 45, Kazuhiro Mizukami 46, Takashi Shono 47, Ryo Shimoda 48, Tadashi Miike 49, Naoyuki Yamaguchi 50

Affiliations

1 Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan

2 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

3 Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan

4 Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan

5 Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan

6 Department of Gastroenterology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan

7 Department of Gastroenterology, Kobe University, International Clinical Cancer Research Center, Hyogo, Japan

8 Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan

9 Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan

10 Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

11 Department of Gastroenterology, Juntendo University, Tokyo, Japan

12 Department of Gastroenterology and Hepatology, Nagoya University, Graduate School of Medicine, Nagoya, Japan

13 Department of Gastroenterology, Kindai University, Osaka, Japan

14 Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

15 Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan

16 Department of Gastroenterology, Sasebo City General Hospital, Nagasaki, Japan

17 Department of Gastroenterology, Sapporo Medical University, Hokkaido, Japan

18 Department of Gastroenterology, Hokkaido University Hospital, Hokkaido, Japan

19 Gastroenterology, Otaru Ekisaikai Hospital, Hokkaido, Japan

20 Department of Gastroenterology, Fukushima Medical University, School of Medicine, Fukushima, Japan

21 Department of Coloproctology, Fukushima Medical University, Aizu Medical Center, Fukushima, Japan

22 Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

23 Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

24 Department of Endoscopy, The Jikei University, School of Medicine, Tokyo, Japan

25 Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University, School of Medicine, Tokyo, Japan

26 Health Management Center, Toranomon Hospital, Tokyo, Japan

27 Department of Gastroenterology and Hepatology, Gunma University, Graduate School of Medicine, Gunma, Japan

28 Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan

29 Department of Gastroenterology, Nishizin Hospital, Kyoto, Japan

30 Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan

31 Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, Japan

32 Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan

33 Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan

34 Department of Gastroenterology, Otsu City Hospital, Shiga, Japan

35 Department of Gastroenterology, Nara City Hospital, Nara, Japan

36 Department of Gastroenterology, Kyoto City Hospital, Kyoto, Japan

37 Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

38 Gastrointestinal Center, Sano Hospital, Hyogo, Japan

39 Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

40 Department of Gastroenterology, Kyoto Katsura Hospital, Kyoto, Japan

41 Department of Gastroenterology, Omi Medical Center, Shiga, Japan

42 Department of Gastroenterology, Okayama University, Okayama, Japan

43 Department of Gastroenterology and Oncology, Tokushima University, Graduate School of Biomedical Sciences, Tokushima, Japan

44 Department of Gastroenterology, Nagasaki Medical Center, Nagasaki, Japan

45 Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

46 Faculty of Medicine, Oita University, Oita, Japan

47 Department of Gastroenterology, Kumamoto Central Hospital, Kumamoto, Japan

48 Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan

49 Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

50 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan

Summary

AI Generated

Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Delayed bleeding after colorectal endoscopic submucosal dissection (ESD) is a significant adverse event in patients receiving anticoagulants. While early resumption is recommended to prevent thromboembolism, the optimal timing remains controversial. This study aimed to determine the optimal timing for resuming anticoagulants after colorectal ESD, with an additional focus on the interaction between direct oral anticoagulant (DOAC) types and renal function.

Aims & Methods

This study was a post-hoc analysis of the ABCD- J study, which included 34,450 colorectal ESD cases across 47 Japanese institutions. We retrospectively analyzed 1,309 colorectal ESD cases in patients receiving anticoagulants (952 on DOACs and 357 on warfarin). Patients were categorized by resumption timing: Early (resumption within postoperative day [POD] 1) and Late (resumption on POD 2 or later). Propensity score matching (PSM) was used to compare delayed bleeding rates in the overall, DOAC, and warfarin cohorts. Additionally, an exploratory sub-analysis was conducted using the unmatched DOAC cohort to evaluate drug-specific risks stratified by renal function (eGFR ≥60 vs. <60 mL/min/1.73m²).

Results

In the PSM analysis, no significant difference in delayed bleeding rates was observed between the Early and Late groups for the overall cohort (9.6% vs. 6.6%, p=0.201), DOAC group (9.0% vs. 6.2%, p=0.358), or warfarin group (11.4% vs. 6.7%, p=0.336) (Table 1). However, regarding cases with delayed bleeding before resumption, the bleeding rate was significantly lower in the Early group (1.18% vs. 3.23%, p = 0.013). Conversely, among those after resumption, it was significantly higher in the Early group (9.42% vs. 6.02%, p = 0.041). The drug-specific sub-analysis revealed a critical interaction between renal function and DOAC type (Table 1). Notably, in patients with impaired renal function (eGFR <60), early resumption of dabigatran resulted in a remarkably high delayed bleeding rate of 34.4%, compared to 15.9% in those with preserved renal function (eGFR ≥60). Other DOACs, including edoxaban, apixaban, and rivaroxaban, showed more stable safety profiles regardless of renal function.

Table 1: Delayed Bleeding Rates Focusing on Resumption Timing
		Timing of Anticoagulant Resumption
	Population	Early (within POD 1)	Late (POD ≥ 2)	p-value
Overall (Matched)	-	9.6% (32/334)	6.6% (22/334)	0.201
DOAC (Matched)	-	9.0% (10/210)	6.2% (13/210)	0.358
Warfarin (Matched)	-	11.4% (12/105)	6.7% (7/105)	0.336
Dabigatran (Unmatched)	eGFR ≥ 60	15.9% (7/44)	0.0% (0/23)	0.086
Dabigatran (Unmatched)	eGFR < 60	34.4% (11/32)	12.5% (1/8)	0.396
Edoxaban (Unmatched)	eGFR ≥ 60	10.8% (13/120)	3.1% (1/32)	0.303
Edoxaban (Unmatched)	eGFR < 60	6.1% (7/115)	5.9% (2/34)	1.000

Conclusion

The early resumption of anticoagulants within 1 day post-ESD did not significantly increase delayed bleeding. However, our findings highlight the necessity of an individualized approach; specifically, extreme caution is required when resuming dabigatran early in patients with renal impairment.

Event

UEG Week Barcelona 2026

Topics

Digestive Oncology Endoscopy Colorectal

Submission format

Abstract

Session

Endoscopic resection: Cut, cure, prevent

Citation

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

Published

2026

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