{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T18:57:29Z","timestamp":1774637849940,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Device-assisted enteroscopy (DAE) is capable of evaluating the entire gastrointestinal tract, identifying multiple lesions. Nevertheless, DAE\u2019s diagnostic yield is suboptimal. Convolutional neural networks (CNN) are multi-layer architecture artificial intelligence models suitable for image analysis, but there is a lack of studies about their application in DAE. Our group aimed to develop a multidevice CNN for panendoscopic detection of clinically relevant lesions during DAE. In total, 338 exams performed in two specialized centers were retrospectively evaluated, with 152 single-balloon enteroscopies (Fujifilm\u00ae, Porto, Portugal), 172 double-balloon enteroscopies (Olympus\u00ae, Porto, Portugal) and 14 motorized spiral enteroscopies (Olympus\u00ae, Porto, Portugal); then, 40,655 images were divided in a training dataset (90% of the images, n = 36,599) and testing dataset (10% of the images, n = 4066) used to evaluate the model. The CNN\u2019s output was compared to an expert consensus classification. The model was evaluated by its sensitivity, specificity, positive (PPV) and negative predictive values (NPV), accuracy and area under the precision recall curve (AUC-PR). The CNN had an 88.9% sensitivity, 98.9% specificity, 95.8% PPV, 97.1% NPV, 96.8% accuracy and an AUC-PR of 0.97. Our group developed the first multidevice CNN for panendoscopic detection of clinically relevant lesions during DAE. The development of accurate deep learning models is of utmost importance for increasing the diagnostic yield of DAE-based panendoscopy.<\/jats:p>","DOI":"10.3390\/cancers16010208","type":"journal-article","created":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T13:02:58Z","timestamp":1704114178000},"page":"208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Artificial Intelligence and Panendoscopy\u2014Automatic Detection of Clinically Relevant Lesions in Multibrand Device-Assisted Enteroscopy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5890-7049","authenticated-orcid":false,"given":"Francisco","family":"Mendes","sequence":"first","affiliation":[{"name":"Alameda Professor Hern\u00e2ni Monteiro, Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0340-0830","authenticated-orcid":false,"given":"Miguel","family":"Mascarenhas","sequence":"additional","affiliation":[{"name":"Alameda Professor Hern\u00e2ni Monteiro, Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"given":"Tiago","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Alameda Professor Hern\u00e2ni Monteiro, Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"given":"Jo\u00e3o","family":"Afonso","sequence":"additional","affiliation":[{"name":"Alameda Professor Hern\u00e2ni Monteiro, Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"given":"Pedro","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Alameda Professor Hern\u00e2ni Monteiro, Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0484-4804","authenticated-orcid":false,"given":"Miguel","family":"Martins","sequence":"additional","affiliation":[{"name":"Alameda Professor Hern\u00e2ni Monteiro, Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal"}]},{"given":"H\u00e9lder","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Alameda Professor Hern\u00e2ni Monteiro, Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"given":"Patr\u00edcia","family":"Andrade","sequence":"additional","affiliation":[{"name":"Alameda Professor Hern\u00e2ni Monteiro, Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"given":"Jo\u00e3o P. S.","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal"},{"name":"DigestAID\u2014Digestive Artificial Intelligence Development, R. Alfredo Allen n\u00b0. 455\/461, 4200-135 Porto, Portugal"}]},{"given":"Miguel","family":"Mascarenhas Saraiva","sequence":"additional","affiliation":[{"name":"ManopH Gastroenterology Clinic, R. de S\u00e1 da Bandeira 752, 4000-432 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9387-9872","authenticated-orcid":false,"given":"Guilherme","family":"Macedo","sequence":"additional","affiliation":[{"name":"Alameda Professor Hern\u00e2ni Monteiro, Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4050-345 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1055\/a-1973-3796","article-title":"Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline\u2014Update 2022","volume":"55","author":"Pennazio","year":"2023","journal-title":"Endoscopy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1016\/j.gie.2020.10.028","article-title":"Total motorized spiral enteroscopy: First prospective clinical feasibility trial","volume":"93","author":"Beyna","year":"2021","journal-title":"Gastrointest. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1055\/a-0576-0566","article-title":"Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review","volume":"50","author":"Rondonotti","year":"2018","journal-title":"Endoscopy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"774","DOI":"10.3748\/wjg.v17.i6.774","article-title":"Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding","volume":"17","author":"Goenka","year":"2011","journal-title":"World J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1111\/apt.16049","article-title":"Systematic review with meta-analysis: Efficacy of balloon-assisted enteroscopy for dilation of small bowel Crohn\u2019s disease strictures","volume":"52","author":"Bettenworth","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.giec.2016.08.005","article-title":"Neoplastic Diseases of the Small Bowel","volume":"27","author":"Rondonotti","year":"2017","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.gie.2011.04.001","article-title":"Nonsurgical management of small-bowel polyps in Peutz-Jeghers syndrome with extensive polypectomy by using double-balloon endoscopy","volume":"74","author":"Sakamoto","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1111\/j.1440-1746.2010.06530.x","article-title":"Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: An updated meta-analysis","volume":"26","author":"Teshima","year":"2011","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.dld.2017.01.139","article-title":"A prospective randomised study comparing double-balloon colonoscopy and conventional colonoscopy in pre-defined technically difficult cases","volume":"49","author":"Despott","year":"2017","journal-title":"Dig. Liver Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"792668","DOI":"10.3389\/fmed.2021.792668","article-title":"The Evolution of Device-Assisted Enteroscopy: From Sonde Enteroscopy to Motorized Spiral Enteroscopy","volume":"8","author":"Nehme","year":"2021","journal-title":"Front. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s13244-018-0639-9","article-title":"Convolutional neural networks: An overview and application in radiology","volume":"9","author":"Yamashita","year":"2018","journal-title":"Insights Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1161\/CIRCULATIONAHA.121.057480","article-title":"ECG-Based Deep Learning and Clinical Risk Factors to Predict Atrial Fibrillation","volume":"145","author":"Khurshid","year":"2022","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1111\/cyt.13260","article-title":"Using a deep learning neural network for the identification of malignant cells in effusion cytology material","volume":"34","author":"Sanyal","year":"2023","journal-title":"Cytopathology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.neunet.2023.06.013","article-title":"A multi-modal deep neural network for multi-class liver cancer diagnosis","volume":"165","author":"Khan","year":"2023","journal-title":"Neural Netw."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E171","DOI":"10.1055\/a-1675-1941","article-title":"Deep learning and colon capsule endoscopy: Automatic detection of blood and colonic mucosal lesions using a convolutional neural network","volume":"10","author":"Mascarenhas","year":"2022","journal-title":"Endosc. Int. Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"879","DOI":"10.3748\/wjg.v29.i5.879","article-title":"Convolutional neural network-based segmentation network applied to image recognition of angiodysplasias lesion under capsule endoscopy","volume":"29","author":"Chu","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.gie.2020.04.039","article-title":"Deep learning for wireless capsule endoscopy: A systematic review and meta-analysis","volume":"92","author":"Soffer","year":"2020","journal-title":"Gastrointest. Endosc."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Mascarenhas Saraiva, M., Ribeiro, T., Afonso, J., Andrade, P., Cardoso, P., Ferreira, J., Cardoso, H., and Macedo, G. (2021). Deep Learning and Device-Assisted Enteroscopy: Automatic Detection of Gastrointestinal Angioectasia. Medicina, 57.","DOI":"10.3390\/medicina57121378"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Martins, M., Mascarenhas, M., Afonso, J., Ribeiro, T., Cardoso, P., Mendes, F., Cardoso, H., Andrade, P., Ferreira, J., and Macedo, G. (2023). Deep-Learning and Device-Assisted Enteroscopy: Automatic Panendoscopic Detection of Ulcers and Erosions. Medicina, 59.","DOI":"10.3390\/medicina59010172"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e00514","DOI":"10.14309\/ctg.0000000000000514","article-title":"Artificial Intelligence and Device-Assisted Enteroscopy: Automatic Detection of Enteric Protruding Lesions Using a Convolutional Neural Network","volume":"13","author":"Cardoso","year":"2022","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_21","first-page":"2825","article-title":"Scikit-learn: Machine Learning in Python","volume":"12","author":"Pedregosa","year":"2011","journal-title":"J. Mach. Learn. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1021\/ci025626i","article-title":"Assessing model fit by cross-validation","volume":"43","author":"Hawkins","year":"2003","journal-title":"J. Chem. Inf. Comput. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"189","DOI":"10.4258\/hir.2021.27.3.189","article-title":"Impact of the Choice of Cross-Validation Techniques on the Results of Machine Learning-Based Diagnostic Applications","volume":"27","author":"Tougui","year":"2021","journal-title":"Healthc. Inform. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1016\/j.jtcvs.2021.07.041","article-title":"Limitations of receiver operating characteristic curve on imbalanced data: Assist device mortality risk scores","volume":"165","author":"Movahedi","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1007\/s00330-014-3487-0","article-title":"Disadvantages of using the area under the receiver operating characteristic curve to assess imaging tests: A discussion and proposal for an alternative approach","volume":"25","author":"Halligan","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Saito, T., and Rehmsmeier, M. (2015). The precision-recall plot is more informative than the ROC plot when evaluating binary classifiers on imbalanced datasets. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0118432"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"688969","DOI":"10.3389\/fdata.2021.688969","article-title":"Principles and Practice of Explainable Machine Learning","volume":"4","author":"Belle","year":"2021","journal-title":"Front. Big Data"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Linardatos, P., Papastefanopoulos, V., and Kotsiantis, S. (2020). Explainable AI: A Review of Machine Learning Interpretability Methods. Entropy, 23.","DOI":"10.3390\/e23010018"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Mascarenhas, M., Afonso, J., Ribeiro, T., Andrade, P., Cardoso, H., and Macedo, G. (2023). The Promise of Artificial Intelligence in Digestive Healthcare and the Bioethics Challenges It Presents. Medicina, 59.","DOI":"10.3390\/medicina59040790"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"l886","DOI":"10.1136\/bmj.l886","article-title":"Clinical applications of machine learning algorithms: Beyond the black box","volume":"364","author":"Watson","year":"2019","journal-title":"BMJ"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1126\/science.aat5991","article-title":"How AI can be a force for good","volume":"361","author":"Taddeo","year":"2018","journal-title":"Science"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41591-018-0307-0","article-title":"The practical implementation of artificial intelligence technologies in medicine","volume":"25","author":"He","year":"2019","journal-title":"Nat. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"160018","DOI":"10.1038\/sdata.2016.18","article-title":"The FAIR Guiding Principles for scientific data management and stewardship","volume":"3","author":"Wilkinson","year":"2016","journal-title":"Sci. Data"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1038\/s41746-023-00891-y","article-title":"Impact of primary to secondary care data sharing on care quality in NHS England hospitals","volume":"6","author":"Zhang","year":"2023","journal-title":"NPJ Digit. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"ooad055","DOI":"10.1093\/jamiaopen\/ooad055","article-title":"Development and implementation of an interoperability tool across state public health agency\u2019s disease surveillance and immunization information systems","volume":"6","author":"Rajamani","year":"2023","journal-title":"JAMIA Open"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1177\/19322968231186976","article-title":"First Generation of a Modular Interoperable Closed-Loop System for Automated Insulin Delivery in Patients With Type 1 Diabetes: Lessons From Trials and Real-Life Data","volume":"17","author":"Benhamou","year":"2023","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6039","DOI":"10.1038\/s41467-022-33128-9","article-title":"Technology readiness levels for machine learning systems","volume":"13","author":"Lavin","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s11517-021-02486-9","article-title":"Automated detection of ulcers and erosions in capsule endoscopy images using a convolutional neural network","volume":"60","author":"Afonso","year":"2022","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Ribeiro, T., Mascarenhas Saraiva, M.J., Afonso, J., Cardoso, P., Mendes, F., Martins, M., Andrade, A.P., Cardoso, H., Mascarenhas Saraiva, M., and Ferreira, J. (2023). Design of a Convolutional Neural Network as a Deep Learning Tool for the Automatic Classification of Small-Bowel Cleansing in Capsule Endoscopy. Medicina, 59.","DOI":"10.3390\/medicina59040810"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Cherubini, A., and Dinh, N.N. (2023). A Review of the Technology, Training, and Assessment Methods for the First Real-Time AI-Enhanced Medical Device for Endoscopy. Bioengineering, 10.","DOI":"10.3390\/bioengineering10040404"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e148","DOI":"10.1002\/deo2.148","article-title":"Safety and efficacy of the novel motorized power spiral enteroscopy: A single-center experience","volume":"3","author":"Singh","year":"2023","journal-title":"DEN Open"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"E1860","DOI":"10.1055\/a-1548-6572","article-title":"Colon capsule for panendoscopy: A narrow window of opportunity","volume":"9","author":"Rondonotti","year":"2021","journal-title":"Endosc. Int. Open"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"E584","DOI":"10.1055\/a-1785-4810","article-title":"Colon capsule endoscopy as panendoscopy: Using current knowledge to enhance possibilities","volume":"10","author":"Vuik","year":"2022","journal-title":"Endosc. Int. Open"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E1361","DOI":"10.1055\/a-1507-4980","article-title":"A deep learning framework for autonomous detection and classification of Crohn\u2019s disease lesions in the small bowel and colon with capsule endoscopy","volume":"9","author":"Majtner","year":"2021","journal-title":"Endosc. Int. Open"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1000726","DOI":"10.3389\/fmed.2022.1000726","article-title":"Artificial intelligence to improve polyp detection and screening time in colon capsule endoscopy","volume":"9","author":"Gilabert","year":"2022","journal-title":"Front. 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