{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T04:39:56Z","timestamp":1792384796914,"version":"4.4.0"},"reference-count":13,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2027,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    During peroral cholangioscopy\u2010guided electrohydraulic lithotripsy (EHL), stone fragmentation obscures the visual field (the \u201csnowstorm effect\u201d), and visualization quality has been assessed only subjectively. This proof\u2010of\u2010concept study explored the feasibility of a deep\u2010learning method for objectively quantifying visualization quality during EHL and, as an exploratory application, compared viscous gel immersion with saline irrigation. A ResNet\u201018 model was trained on expert\u2010annotated frames (5\u2010point scale) from three development cases. For independent validation, 120 frames from 12 previously unseen comparison cases were scored by two blinded endoscopists (inter\u2010reader weighted\n                    <jats:italic>\u03ba<\/jats:italic>\n                    = 0.98). The model showed only moderate agreement with their consensus (weighted\n                    <jats:italic>\u03ba<\/jats:italic>\n                    = 0.60; accuracy 70.8%); because the validation sample was enriched for predicted\u2010usable frames, metrics re\u2010weighted to the natural frame distribution gave sensitivity 29.8% and specificity 93.5%, indicating systematic under\u2010detection of usable views. Agreement did not differ systematically between gel and saline frames. The High\u2010Quality View Rate (HQVR) was the proportion of EHL\u2010phase frames scored Good\/Excellent. In a patient\u2010level comparison, median HQVR was 22.7% for gel versus 8.4% for saline (exact Mann\u2013Whitney U,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.15, not significant); in post hoc exploratory analyses, a threshold\u2010independent mean predicted score differed (1.65\u00a0vs. 1.35,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.005) and the longest continuous usable interval favored gel (median 24.4\u00a0vs. 5.2 s). Mild cholangitis occurred in 1\/5 gel and 4\/7 saline patients. Training such a model is feasible, but it is not yet a validated measurement tool, and the gel\u2010versus\u2010saline signal is hypothesis\u2010generating only. Larger multi\u2010case training and prospective validation are required.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration<\/jats:bold>\n                    : N\/A\n                  <\/jats:p>","DOI":"10.1002\/deo2.70454","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T03:51:08Z","timestamp":1792381868000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility of a Deep\u2010Learning Model for Objective Visualization\u2010Quality Assessment During Cholangioscopy\u2010Guided Lithotripsy: A Proof\u2010of\u2010Concept Study"],"prefix":"10.1002","volume":"7","author":[{"given":"Hideki","family":"Kamada","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoyuki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Yamana","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Namima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syunsuke","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironobu","family":"Suto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Faculty of Medicine Kagawa University  Takamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Okano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Faculty of Medicine Kagawa University  Takamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Kobara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.10.017"},{"issue":"4","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"457","DOI":"10.5009\/gnl17352","article-title":"Electrohydraulic Lithotripsy for Difficult Bile Duct Stones Under Endoscopic Retrograde Cholangiopancreatography and Peroral Transluminal Cholangioscopy Guidance","volume":"12","author":"Ogura T.","year":"2018","journal-title":"Gut and 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