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AI-powered systems may improve consistency, but dataset heterogeneity has hindered clinical translation. We developed and evaluated a deep learning framework for standardized Mayo Endoscopic Score (MES) prediction across adult and pediatric populations from diverse regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>Using three multi-institutional datasets, we trained and validated convolutional neural network models to predict MES. The primary dataset (LIMUC; 564 adults, 11\u200a276 images, Turkey) supported model development, with external validation on TMC (308 adults, 7978 images, China) and the Emory Pediatric dataset (EPC; 80 children, 113 images, USA). Two models were developed: UC-Re for binary remission classification (MES 0-1 vs 2-3) and UC-MES for four-class grading (MES 0-3). Imaging artifacts were corrected using inpainting, and Fourier-Spatial Image Harmonization (FSIH) mitigated inter-institutional domain shifts. Performance was evaluated using area under the operating characteristic curve (AUC), F1-score, and quadratic weighted kappa (QWK).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>UC-Re achieved AUCs of 0.98, 0.95, and 0.98 across LIMUC, TMC, and EPC, with F1-scores of 0.92, 0.87, and 0.93, respectively. UC-MES demonstrated strong ordinal consistency (QWK = 0.81-0.85), comparable to inter-expert agreement (QWK\u2009=\u20090.88). Most misclassifications occurred between adjacent MES categories, reflecting human-like patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This novel AI-based framework predicts MES across geographically diverse adult and pediatric UC datasets. Its strong performance, including comparability to expert gastroenterologists in EPC, supports its potential as a decision-support tool for standardized endoscopic monitoring. However, prospective multicenter validation is warranted prior to routine clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjag122","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T11:54:54Z","timestamp":1784807694000},"source":"Crossref","is-referenced-by-count":0,"title":["Automated AI-based Mayo Endoscopic Scoring for ulcerative colitis across adult and pediatric cohorts from diverse populations"],"prefix":"10.1093","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1598-4287","authenticated-orcid":false,"given":"Kamal","family":"Hammouda","sequence":"first","affiliation":[{"name":"Wallace H. 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Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology , Atlanta, GA, 30322,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chathruckan","family":"Rajendra","sequence":"additional","affiliation":[{"name":"Department of Pediatrics & Pediatric Research Institute, Emory University , Atlanta, GA, 30322,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyojeong","family":"Lee","sequence":"additional","affiliation":[{"name":"Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology , Atlanta, GA, 30322,","place":["United States"]},{"name":"Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine , Seoul, 05505,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar Almahfouz","family":"Nasser","sequence":"additional","affiliation":[{"name":"Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology , Atlanta, GA, 30322,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmistha","family":"Rudra","sequence":"additional","affiliation":[{"name":"Department of Pediatrics & Pediatric Research Institute, Emory University , Atlanta, GA, 30322,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasantha","family":"Kolachala","sequence":"additional","affiliation":[{"name":"Department of Pediatrics & Pediatric Research Institute, Emory University , Atlanta, GA, 30322,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Diefendorf","sequence":"additional","affiliation":[{"name":"Department of Pediatrics & Pediatric Research Institute, Emory University , Atlanta, GA, 30322,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Geiculescu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics & Pediatric Research Institute, Emory University , Atlanta, GA, 30322,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushma","family":"Maddipatla","sequence":"additional","affiliation":[{"name":"Department of Pediatrics & Pediatric Research Institute, Emory University , Atlanta, GA, 30322,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anant","family":"Madabhushi","sequence":"additional","affiliation":[{"name":"Wallace H. 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