{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:12:21Z","timestamp":1790809941449,"version":"4.1.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"name":"Hubei Province Major Science and Technology Innovation Project","award":["2018-916-000-008"],"award-info":[{"award-number":["2018-916-000-008"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["81672387"],"award-info":[{"award-number":["81672387"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Project of Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision","award":["2018BCC337"],"award-info":[{"award-number":["2018BCC337"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2002The study aimed to construct an intelligent difficulty scoring and assistance system (DSAS) for endoscopic retrograde cholangiopancreatography (ERCP) treatment of common bile duct (CBD) stones.<\/jats:p><jats:p>\n          Methods\u20021954 cholangiograms were collected from three hospitals for training and testing the DSAS.\u200aThe D-LinkNet34 and U-Net were adopted to segment the CBD, stones, and duodenoscope. Based on the segmentation results, the stone size, distal CBD diameter, distal CBD arm, and distal CBD angulation were estimated. The performance of segmentation and estimation was assessed by mean intersection over union (mIoU) and average relative error. A technical difficulty scoring scale, which was used for assessing the technical difficulty of CBD stone removal, was developed and validated. We also analyzed the relationship between scores evaluated by the DSAS and clinical indicators including stone clearance rate and need for endoscopic papillary large-balloon dilation (EPLBD) and lithotripsy.<\/jats:p><jats:p>\n          Results\u2002The mIoU values of the stone, CBD, and duodenoscope segmentation were 68.35\u200a%, 86.42\u200a%, and 95.85\u200a%, respectively. The estimation performance of the DSAS was superior to nonexpert endoscopists. In addition, the technical difficulty scoring performance of the DSAS was more consistent with expert endoscopists than two nonexpert endoscopists. A DSAS assessment score \u2265\u200a2 was correlated with lower stone clearance rates and more frequent EPLBD. <\/jats:p><jats:p>\n          Conclusions\u2002An intelligent DSAS based on deep learning was developed. The DSAS could assist endoscopists by automatically scoring the technical difficulty of CBD stone extraction, and guiding the choice of therapeutic approach and appropriate accessories during ERCP.<\/jats:p>","DOI":"10.1055\/a-1244-5698","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T23:11:03Z","timestamp":1598310663000},"page":"491-498","source":"Crossref","is-referenced-by-count":30,"title":["Intelligent difficulty scoring and assistance system for endoscopic extraction of common bile duct stones based on deep learning: multicenter study"],"prefix":"10.1055","volume":"53","author":[{"given":"Li","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Lu","sequence":"first","affiliation":[{"name":"State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoping","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianlian","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongyin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deqing","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tenth People Hospital of Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dehua","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingyuan","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyue","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongchao","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijie","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dexin","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfei","family":"Zhong","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Tenth People Hospital of Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honggang","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China"},{"name":"Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,11,9]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.bpg.2006.05.009","article-title":"Gallstone disease: epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic)","volume":"20","author":"S Tazuma","year":"2006","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12876-018-0764-4","article-title":"Endoscopic retrograde cholangiopancreatography in the elderly: results of a retrospective study and a geriatricians\u2019 point of view","volume":"18","author":"M Galeazzi","year":"2018","journal-title":"BMC Gastroenterol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.tgie.2019.04.002","article-title":"Endoscopic treatment of ERCP-related duodenal perforation","volume":"21","author":"N Evans","year":"2019","journal-title":"Tech Gastrointest Endosc"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.gie.2018.10.001","article-title":"ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis","volume":"89","author":"J L Buxbaum","year":"2019","journal-title":"Gastrointest Endosc"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"51","author":"G Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1136\/gutjnl-2016-312317","article-title":"Updated guideline on the management of common bile duct stones (CBDS)","volume":"66","author":"E Williams","year":"2017","journal-title":"Gut"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1007\/s10620-012-2494-8","article-title":"Factors predictive of adverse events following endoscopic papillary large balloon dilation: results from a multicenter series","volume":"58","author":"S J Park","year":"2013","journal-title":"Dig Dis Sci"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1038\/ajg.2010.421","article-title":"Large balloon dilation vs. mechanical lithotripsy for the management of large bile duct stones: a prospective randomized study","volume":"106","author":"G Stefanidis","year":"2011","journal-title":"Am J Gastroenterol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.dld.2012.10.015","article-title":"Sixty- versus thirty-seconds papillary balloon dilation after sphincterotomy for the treatment of large bile duct stones: a randomized controlled trial","volume":"45","author":"G A Paspatis","year":"2013","journal-title":"Dig Liver Dis"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1053\/j.gastro.2012.10.027","article-title":"Randomized trial of endoscopic sphincterotomy with balloon dilation versus endoscopic sphincterotomy alone for removal of bile duct stones","volume":"144","author":"A Y Teoh","year":"2013","journal-title":"Gastroenterology"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.gie.2007.04.033","article-title":"Factors influencing the technical difficulty of endoscopic clearance of bile duct stones","volume":"66","author":"H J Kim","year":"2007","journal-title":"Gastrointest Endosc"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1038\/nature14539","article-title":"Deep learning","volume":"521","author":"Y Lecun","year":"2015","journal-title":"Nature"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.cell.2017.08.007","article-title":"High-definition medicine","volume":"170","author":"A Torkamani","year":"2017","journal-title":"Cell"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1136\/gutjnl-2018-317366","article-title":"Randomised controlled trial of WISENSE, a real-time quality improving system for monitoring blind spots during esophagogastroduodenoscopy","volume":"68","author":"L Wu","year":"2019","journal-title":"Gut"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1109\/TPAMI.2016.2572683","article-title":"Fully convolutional networks for semantic segmentation","volume":"39","author":"E Shelhamer","year":"2017","journal-title":"IEEE Trans Pattern Anal Mach Intell"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1007\/s11548-019-01989-z","article-title":"Liver tissue segmentation in multiphase CT scans using cascaded convolutional neural networks","volume":"14","author":"F Ouhmich","year":"2019","journal-title":"Int J Comput Assist Radiol Surg"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"10134","DOI":"10.1117\/12.2254361","article-title":"Fully convolutional neural networks for polyp segmentation in colonoscopy","author":"P Brandao","year":"2017","journal-title":"Proc SPIE Int Soc Opt Eng"},{"key":"ref18","doi-asserted-by":"publisher","volume-title":"U-Net: convolutional networks for biomedical image segmentation","author":"O Ronneberger","DOI":"10.1007\/978-3-319-24574-4_28"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.gie.2007.04.033","article-title":"Factors influencing the technical difficulty of endoscopic clearance of bile duct stones","volume":"66","author":"H J Kim","year":"2007","journal-title":"Gastrointest Endosc"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1136\/pmj.79.934.467","article-title":"Objective evaluation of ERCP procedures: a simple grading scale for evaluating technical difficulty","volume":"79","author":"K Ragunath","year":"2002","journal-title":"Postgrad Med J"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1055\/s-0032-1309345","article-title":"What predicts failed cannulation and therapy at ERCP? Results of a large-scale multicenter analysis.","volume":"44","author":"L R Scheker","year":"2012","journal-title":"Endoscopy"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/S0016-5107(00)70285-9","article-title":"Grading ERCPs by degree of difficulty: a new concept to produce more meaningful outcome data","volume":"51","author":"S M Schutz","year":"2000","journal-title":"Gastrointest Endosc"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s11938-019-00234-5","article-title":"Endoscopic papillary large balloon dilation versus endoscopic sphincterotomy for treatment of bile duct stones","volume":"17","author":"A Haseeb","year":"2019","journal-title":"Curr Treat Options Gastroenterol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1055\/s-0035-1569580","article-title":"The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures","volume":"48","author":"M Rutter","year":"2015","journal-title":"Endoscopy"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s11938-006-0031-6","article-title":"Difficult bile duct stones","volume":"9","author":"L Mchenry","year":"2006","journal-title":"Curr Treat Options Gastroenterol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"51","author":"G Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.gie.2007.02.033","article-title":"Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal of bile-duct stones","volume":"66","author":"J H Heo","year":"2007","journal-title":"Gastrointest Endosc"},{"key":"ref29","first-page":"278","article-title":"Large balloon dilation vs","volume":"106","author":"G Stefanidis","year":"2011","journal-title":"mechanical lithotripsy for the management of large bile duct stones: a prospective randomized study. Am J Gastroenterol"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1244-5698.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T23:35:06Z","timestamp":1661211306000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1244-5698"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,21]]},"references-count":28,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2021,4,22]]},"published-print":{"date-parts":[[2021,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1244-5698","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,8,21]]},"published":{"date-parts":[[2020,8,21]]}}}