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UNDERWATER ENDOSCOPIC SUBMUCOSAL DISSECTION (U-ESD) VERSUS GAS ENDOSCOPIC SUBMUCOSAL DISSECTION (G-ESD) FOR NON-PEDUNCULATED COLORECTAL LESIONS: PRELIMINARY RESULTS

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Introduction

Endoscopic Submucosal Dissection (ESD) is the best endoscopic technique that enables en bloc resection of superficial colorectal neoplasms.Despite its effectiveness, ESD is not very widespread in Western countries due to technical complexity, long procedure times, and a steep learning curve. These barriers have created a significant gap in adoption and outcomes between Eastern and Western centers. Underwater ESD (U-ESD) has been introduced to simplify the procedure. This study aimed to evaluate the effectiveness of U-ESD versus conventional gas-based ESD (G-ESD) in a Western center, focusing on procedural efficiency and safety.

Aims & Methods

This is a single-center, prospective randomized controlled trial conducted at Fondazione Campus Bio-Medico in Rome between December 2024 and April 2025.Forty patients with non-pedunculated colorectal lesions were randomly assigned in a 1:1 ratio to undergo either Underwater ESD (U-ESD) or conventional ESD with insufflation of Carbon Dioxide (CO2) (G-ESD).The primary outcome was total procedure time. Secondary outcomes included dissection speed, en bloc and R0 resection rates, use of hemostatic forceps, and the incidence of adverse events such as delayed bleeding, perforation, and post-ESD coagulation syndrome (PECS).

Results

A total of 40 patients referred to our endoscopic unit for ESD between December 2024 and April 2025. The mean size of the colorectal lesions was 57.4 mm and 40.7 mm in the U-ESD and G-ESD groups. The location of the lesions was in the rectum in 15% and 55% of the U-ESD and C-ESD groups, respectively; in the right side of the colon in 35% and 20% of the U-ESD and G-ESD groups, respectively. The morphology of LST was classified as LST-nongranular in 20 % and 25% of the U-ESD and G-ESD groups, respectively; as LST granular in 60% and 35% of the U-ESD and G-ESD groups, respectively. Fibrosis (grade 1 and 2) was present in 45% and 30% of the U-ESD and G-ESD groups, respectively. The mean total procedure time was shorter in the U-ESD group compared with the G-ESD group (53.3 ±33 minutes vs 78.7 ± 25.6 minutes; mean difference,–25.4 minutes; P=0.009).Mean dissection speed was faster in the U-ESD group compared with the G-ESD group (42 ± 26.3 mm2/min vs 13.3 ± 8 mm2/min; mean difference, 28.7 mm2/min; P= 0.001). En bloc and R0 resection rates in both groups were 100%. The use of a hemostatic forceps was significantly lower in U-ESD compared G-ESD (40% vs 90%, P= 0.001). Delayed bleeding occurred in only one patient in G-ESD group and was managed successfully by endoscopic clipping. No perforations occurred in either group. PECS was noted in only one patient in the G-ESD group.

Conclusion

UESD has shown a significantly shorter procedure time and faster dissection speed compared with GESD. These both empower the possibility of considering U-ESD as the preferred colorectal ESD method for colorectal lesions.

UNDERWATER ENDOSCOPIC SUBMUCOSAL DISSECTION (U-ESD) VERSUS GAS ENDOSCOPIC SUBMUCOSAL DISSECTION (G-ESD) FOR NON-PEDUNCULATED COLORECTAL LESIONS: PRELIMINARY RESULTS

Gianluca Andrisani 1, Giulio Antonelli 2, Arianna Andreozzi 1, Giovanni Parente 3, Andrea D'Amico 4, Benito Diana 1, Giulia Parisi 1, Virginia Gregorio 4, Francesco Di Matteo 5

1 Fondazione Campus Bio Medico, Rome, Italy

2 Sapienza Università di Roma at Sant'Andrea University Hospital, Roma, Italy

3 Università degli Studi di Salerno, Grazzanise, Italy

4 Fondazio Campus Bio Medico, Rome, Italy

5 Campus Bio-Medico of Rome, Roma, Italy

Event

UEG Week Berlin 2025

Topics

Colorectal Endoscopy Surgery

Submission format

Abstract

Session

Improving decision-making in colorectal lesions

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Endoscopic intervention

Ian Mark Gralnek 1

1 Ha'Emek Medical Center, Haifa, Israel

Event

UEG Week Berlin 2025

Topics

Endoscopy Radiology & Imaging

Session

Crash course: Lower GI bleeding

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Sense and non-sense of the new nomenclature

Maria Effenberger 1

1 Medical University of Innsbruck, Innsbruck, Austria

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Mechanisms & Personalised Medicine

Session

Challenges in metabolic liver diseases

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Update on hepatorenal syndrome

Raj Mookerjee 1

1 UCL Institute of Hepatology, University College London, UK, London, United Kingdom

Event

UEG Week Berlin 2025

Topics

Hepatobiliary

Session

What's new in complications in chronic liver disease in 2025?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Endoscopic options

Alexander Meining 1

1 Bavarian Cancer Research Center (BZKF), Würzburg, Germany

Event

UEG Week Berlin 2025

Topics

Endoscopy Nurses Paediatrics Surgery

Session

Crash course: Foreign bodies

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Radiological approach in unresectable disease

Christoph Zech 1

1 University Hospital Basel, Basel, Switzerland

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Hepatobiliary Mechanisms & Personalised Medicine Radiology & Imaging

Session

Advancement in management of primary liver tumors

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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ARTIFICIAL INTELLIGENCE FOR CAPSULE ENDOSCOPY IN IBD: MULTICENTER EVALUATION OF ULCER AND EROSION DETECTION

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Introduction

Capsule endoscopy (CE) is a minimally invasive and essential tool for assessing small bowel disorders, especially Crohn’s disease. Accurate detection of ulcers and erosions is vital for evaluating disease activity, guiding treatment, and monitoring therapeutic response. Although CE has revolutionized lesion detection, its manual interpretation remains time-consuming and subject to interobserver variability. Recent advances in artificial intelligence (AI), particularly convolutional neural networks (CNNs), offer promising solutions by enhancing diagnostic accuracy, reducing variability, and improving workflow efficiency. This study aimed to develop and validate a robust AI model capable of detecting and distinguishing small bowel ulcers and erosions across multiple CE platforms and clinical centers.

Aims & Methods

In a prospective, multicenter study conducted between January 2021 and April 2024, data were collected from centers in Portugal, Spain, and the United States. Two CE devices—PillCamSB3 and Olympus EC-10—were used to analyze 137 anonymized exams. The AI-assisted readings generated by a deep learning model were compared to standard-of-care (SoC) interpretations, with an expert consensus panel serving as the reference standard. Performance metrics included sensitivity, specificity, positive and negative predictive values (PPV, NPV), and area under the receiver operating characteristic curve (AUROC).

Results

Expert consensus identified ulcers and erosions in 56 patients (40.9%). Compared to the reference standard, SoC readings achieved 60.7% sensitivity, 98.8% specificity, 97.1% PPV, 78.4% NPV, and 83.2% accuracy. In contrast, the AI-assisted model achieved 94.6% sensitivity, 80.2% specificity, 76.8% PPV, 95.6% NPV, and 86.1% accuracy. The AI model was found to be both non-inferior (p < 0.001) and statistically superior (p < 0.001) to SoC. Notably, it identified 68 lesions, nearly double those detected by SoC (35), and demonstrated consistent performance across devices and centers. The mean AI-assisted reading time was 239 seconds (SD 138 seconds) per exam.

Conclusion

The AI-assisted model significantly outperformed conventional SoC in the detection of small bowel ulcers and erosions, achieving higher sensitivity and overall accuracy while substantially reducing reading time. This is the first multicenter validation of an interoperable AI solution for CE, capable of high diagnostic performance across different devices and clinical environments. These findings highlight the potential of AI to transform endoscopic evaluation and management in inflammatory bowel disease.

ARTIFICIAL INTELLIGENCE FOR CAPSULE ENDOSCOPY IN IBD: MULTICENTER EVALUATION OF ULCER AND EROSION DETECTION

Maria Almeida 1, Miguel Mascarenhas-Saraiva 1, Joana Mota 1, Miguel Martins 1, Francisco Mendes 1, Pedro Cardoso 2, Tiago Ribeiro 3, João Afonso 1, Tiago Cúrdia Gonçalves 4, Pedro Campelo 5, Cláudia Macedo 5, António Miguel Martins Pinto da Costa 6, CECILIO SANTANDER VAQUERO 7, William Preston Sonnier 8, Jack Di Palma 8, João Ferreira 9, José Berkeley Cotter 5, Guilherme Macedo 1

1 Centro Hospitalar São João, Porto, Portugal

2 Department of Gastroenterology, University Hospital Center of São João, Porto, Portugal

3 Centro Hospitalar Universitário de São João, Lordelo - Paredes, Portugal

4 Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal

5 Hospital da Senhora da Oliveira, Guimarães, Portugal

6 Hospital Universitario Puerta de Hierro Majadahonda (Madrid), Madrid, Spain

7 Hosp. Universitario De La Princesa, Madrid, Spain

8 University of South Alabama, Alabama, United States

9 Faculdade de Engenharia da Universidade do Porto, Porto, Portugal

Event

UEG Week Berlin 2025

Topics

Endoscopy Radiology & Imaging IBD

Submission format

Abstract

Session

Advances in the investigation of the small bowel

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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