{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T10:38:16Z","timestamp":1791542296761,"version":"4.3.4"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"crossref","award":["114-E0009"],"award-info":[{"award-number":["114-E0009"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Science and Technology Council","award":["111-2314-B-002-136-MY3 and 114-2314-B-002-245-MY3"],"award-info":[{"award-number":["111-2314-B-002-136-MY3 and 114-2314-B-002-245-MY3"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Diagnosing Helicobacter pylori infection and premalignant gastric conditions typically requires 13C urea breath testing or histological assessment, which are often unavailable in remote areas. A rural-to-center artificial intelligence (AI) model was developed and implemented to automatically evaluate upper endoscopy images from routine clinical practice.<\/jats:p>\n                  <jats:p>Endoscopic images were collected from a rural hospital on Matsu Islands and a tertiary center across Taiwan Strait. During model development (2020\u20132022), AI algorithms were trained, validated, and tested to exclude low-quality and non-gastric images, segment gastric regions, and enhance mucosal features for detecting H. pylori infection and premalignant conditions. During model implementation (2023\u20132024), endoscopic images from a rural hospital were transmitted to the medical center for AI analyses, with results promptly returned.<\/jats:p>\n                  <jats:p>In the development phase, diagnostic accuracies were 92.8% (95%CI 88.9%\u201396.6%) for H. pylori, 88.6% (95%CI 87.2%\u201390.0%) for atrophic gastritis, and 88.0% (95%CI 86.5%\u201389.5%) for intestinal metaplasia. In the implementation phase, 3518 rural residents underwent 13C urea breath testing or pepsinogen testing; 421 with positive results underwent endoscopy. No significant differences were observed between AI-predicted and clinically observed prevalence: H. pylori (13.9% vs. 12.9%; P = 0.55), atrophic gastritis (15.7% vs. 11.9%; P = 0.34), and intestinal metaplasia (27.6% vs. 22.4%; P = 0.32). Implementation-phase diagnostic accuracies were 91.3% (95%CI 88.0%\u201394.6%), 79.9% (95%CI 72.1%\u201386.3%), and 63.4% (95%CI 54.7%\u201371.6%), respectively.<\/jats:p>\n                  <jats:p>AI enabled physicians in resource-limited settings to rapidly assess gastric health using routinely captured endoscopic images, bridging gaps in access and expertise.<\/jats:p>","DOI":"10.1055\/a-2721-6552","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T22:58:06Z","timestamp":1760396286000},"page":"343-354","source":"Crossref","is-referenced-by-count":15,"title":["A rural-to-center artificial intelligence model for diagnosing Helicobacter pylori infection and premalignant gastric conditions using endoscopy images captured in routine practice"],"prefix":"10.1055","volume":"58","clinical-trial-number":[{"clinical-trial-number":"nct05762991","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8160-1216","authenticated-orcid":false,"given":"Yi-Chia","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan"},{"name":"Department of Medical Research, National Taiwan University Hospital, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chu-Song","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Computer Science and Information Engineering, National Taiwan University, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsung-Hsien","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei City, Taiwan"},{"name":"Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Ning","family":"Hsu","sequence":"additional","affiliation":[{"name":"Center of Intelligent Healthcare, National Taiwan University Hospital, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Han","family":"Chen","sequence":"additional","affiliation":[{"name":"Center of Intelligent Healthcare, National Taiwan University Hospital, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ru","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiu-Chi","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan"},{"name":"Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan"},{"name":"Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Jin","family":"Chen","sequence":"additional","affiliation":[{"name":"Nangan Township, Bureau of Public Health, Matsu Islands, Lienchiang County, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu-Jen","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Yang","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan"},{"name":"School of Medicine, ollege of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Chao","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan"},{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan"},{"name":"Taipei Medical University Research Center for Digestive Medicine, Taipei Medical University, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Jong","family":"Bair","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Taitung Mackey Memorial Hospital, Taitung, Taiwan"},{"name":"Mackay Medical College, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyh-Ming","family":"Liou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan"},{"name":"Department of Medicine, National Taiwan University Cancer Center, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiuan-Jung","family":"Chen","sequence":"additional","affiliation":[{"name":"Information Technology Office, National Taiwan University Hospital, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Chung","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pathology, National Yang Ming Chiao Tung University Hospital, Yilan City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung","family":"Chiang","sequence":"additional","affiliation":[{"name":"Taipei Institute of Pathology, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Tung","family":"Shun","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine, National Taiwan University, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jui-Hsuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Lienchiang County Hospital, Nangan Township, Lienchiang County, Matsu Islands, Taiwan, Matsu Islands, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Mo","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Shiang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiun-Yu","family":"Yu","sequence":"additional","affiliation":[{"name":"Department and Graduate Institute of Business Administration, National Taiwan University, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruey-Shan","family":"Guo","sequence":"additional","affiliation":[{"name":"Department and Graduate Institute of Business Administration, National Taiwan University, Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaw-Town","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, Kaohsiung City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref1","volume-title":"Global Cancer Observatory: Cancer Today","author":"J 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