Innovation and Technology in Gastroenterology and Hepatology (ACG 2022) - American College of Gastroenterology (2023)

Highlights from the 2022 American College of Gastroenterology Annual Scientific Meeting, edited by the ACG Innovation and Technology Committee

A recording of the ACG Virtual Grand Rounds on this topic is available:

ACG 2022 Selected! Excellent Science, Expert Discussion
March 2, 2023

Moderators: Vivek Kaul, MD, FACG and Vladimir M. Kushnir, MD
Candidates: Amer AlSamman, MD, Adam Buckholz, MD, MS, Daniel Castaneda, MD, Sarah M. Enslin, PA-C, Daniela Guerrero Vinsard, MD
Participants: Prabhleen Chahal, MD, FACG, Jean Chalhoub, MD, Ryan B. Perumpail, MD, Aparna Repaka, MD

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Innovation and Technology in Gastroenterology and Hepatology (ACG 2022) - American College of Gastroenterology (1)

The mission of the ACG Innovation and Technology Committee is to encourage creativity and innovation in our profession and to work with ACG members and industry to develop meaningful technologies, new technologies and facilitate new research, with the ultimate goal of improving of patient care.

The ACG Annual Scientific Meeting is a unique, internationally recognized platform to showcase these efforts. At the 2022 ACG Annual Scientific Meeting and Graduate Program in Charlotte, NC, colleagues were once again able to gather safely and in person, present their latest research and science, and participate in many high-quality educational sessions. Several members of the ACG Innovation and Technology Committee helped compile short abstracts of selected scientific papers highlighting the latest innovations and technologies presented at ACG 2022.

We hope you found this short review helpful!

Innovation in Pharmacotherapy

inflammatory bowel disease

S712 / Oral 1 – Benefits of high-dose versus low-dose upadacitinib as maintenance therapy in ulcerative colitis patients responding to 8-week upadacitinib induction: results of the U-ACHIEVE phase 3 maintenance trial

Brian G. Feagan, MD, Gareth Parks, DO, Pascal July, MD, Krisztina Gecse, MD, MRCS, MSc, Yuri Sanchez-Gonzalez, PhD, Peter D. Higgins, MD, PhD, MSc

Fagan,and others.Post hoc results from the U-ACHIEVE phase 3 study of upadacitinib (UPA) in ulcerative colitis are presented. Patients (n=451) who responded to 8 weeks of UPA 45 mg induction therapy were randomized to 30 mg, 15 mg, and placebo and followed for 52 weeks. Patients receiving 30 or 15 mg UPA had a higher rate of clinical remission compared with placebo (34.4% and 30.5% vs. 15.8%), as determined by the adjusted Mayo score. Patients who received 30 mg had less disease at the end of 52 weeks, as well as a higher remission rate than those who received 15 mg.

American Journal of Gastroenterology117(10S): p e496, October 2022.DOI:10.14309/01.ajg.0000859488.03460.db

S713 / Oral 37 – Induction and maintenance therapy with risankizumab improves symptoms in patients with moderate to severe Crohn's disease

Edward Lewis, MD · Joana Torres, MD, PhD · James Lindsay, DO · Stefan Schreiber, MD · Ryan Ungaro, MD, MS · Laimas Jonaitis, MD, PhD · Kristina Kligys, PhD · Stijn Van Haaren, MS · Ezequiel Neimark, MD, Javier Zambrano, MD, Yafei Zhang, PhD, Geert D'Haens, MD

Louis,and others.A post hoc analysis of the efficacy and safety of risankizumab, an anti-IL23 monoclonal antibody, was performed in patients with moderate to severe Crohn's disease who had failed or were refractory to prior biologic therapy. Data from the ADVANCE, MOTIVATE and FORTIFY studies. 450 patients were randomized 1:1:1 to receive RZB 360mg versus RZB 180mg versus placebo. 48% of patients had failed 1 prior biologic, 25% had failed 2, and 27% had failed 3 or more biologics. Induction and maintenance therapy were well tolerated, consistent with previous reports. RZB was effective in all patients regardless of the number of prior biologic failures, although success rates were higher in patients with <2 biologic failures. Notably, patients who failed more than 2 biologics with a higher dose of RZB (360 mg) were more likely to achieve endoscopic endpoints compared with 180 mg RZB and placebo.

American Journal of Gastroenterology117(10S): p e496-e497, October 2022.DOI:10.14309/01.ajg.0000859492.75431.51

esophagus

S390 / Oral 14 – Efficacy and safety of on-demand vonoprazan versus placebo in the treatment of heartburn in patients with symptomatic non-erosive reflux (NERD): a phase 2 randomized controlled trial

Ronnie Fass, MD· Michael F. Vaezi, MD· Prateek Sharma, MD· Rena Yadlapati, MD, MS· Barbara Hunt, MS· MD· Eckhard Leifke, MD· David Armstrong, MA, MBBCh, FACG

bin,and others.A Phase 2 study evaluating the efficacy and safety of vonoprazan for the on-demand management of non-erosive reflux was presented. All patients (n=207) initially received vonoprazan 20 mg daily for one week and were then randomized to receive vonoprazan 10 mg, 20 mg, 40 mg, or placebo as needed for 6 weeks. At all three doses, vonoprazan was superior to placebo in relieving symptoms. Symptom relief rates were higher at 40 mg compared to the 10 mg and 20 mg doses (70% vs. 60.6% vs. 56%, respectively).

American Journal of Gastroenterology117(10S): p e272-e273, October 2022.DOI: 10.14309/01.ajg.0000858200.17525.4a

S387 / Oral 11 – Dupilumab improves clinical, symptomatic, histological and endoscopic aspects of EoE for up to 24 weeks: Pooled results from Parts A and B of the Phase 3 LIBERTY-EoE-TREET

Evan Dellon, MD, MPH, Marc Rothenberg, MD, PhD, Albert Brednold, MD, PhD, Alfredo Lusendo, MD, Ikuo Hirano, MD Ph.D., Ph.D., Xian Sun, Ph.D., Kiran Patel , Ph.D., Bethany Beazley, Ph.D.

DeLonghi,Wait. Results of a randomized controlled phase 3 trial of dupilumab in eosinophilic esophagitis are presented. Dupilumab, a monoclonal antibody antagonist of IL-4 and IL-13, was compared with placebo in a group of 240 patients randomized 1:1 and followed for 24 weeks. A higher proportion of dupilumab-treated patients achieved an eosinophil count ≤6/hpf at follow-up (59% vs. 5.9%, p <0.001) and had absolute and percentage changes in Dysphagia Symptom Questionnaire scores. There were also statistical differences between the two groups in terms of improvements in endoscopic reference score and histological grading system, favoring dupilumab over placebo. Dupilumab was safe and the most common adverse events were injection site reactions (33.3%).

American Journal of Gastroenterology117(10S): p e269-e270, October 2022.DOI: 10.14309/01.ajg.0000858188.99771.64

liver

S2910 / Poster D0535 – Transcatheter aortic valve replacement restores liver transplant candidacy in cirrhotic patients

Mirna Kafarani, BS, Omar Shama, MD, Syed-Mohammad Jafri, MD

unfaithful,and others.A case series of patients with severe aortic stenosis, often an insurmountable obstacle to transplantation, is presented. In their cohort, aortic stenosis was corrected with minimally invasive TAVR, and two patients had successful grafts with good graft function at a median follow-up of 27 months. Data on this topic are scarce. This case series demonstrates that resolution of the underlying major valvular heart disease can lead to sufficient cardiovascular recovery to permit liver transplantation.

Stomach

S514/Oral 3 – Virtual reality improves symptoms of functional dyspepsia: results of a randomized, controlled, double-blind pilot study

David Cangemi, MD, Marilia Montenegro, MD, Brennan Spiegel, MD, Brian E. Lacy, MD, PhD, FACG

Can Jamieand others.A randomized, controlled, double-blind study was conducted in 37 patients with functional dyspepsia according to Rome IV criteria who were randomized 2:1 to receive an immersive audio-visual program with virtual reality (n=27) versus a nature video control 2D (n = 10). Patients in each arm used a virtual reality (VR) headset at least once a day for 2 weeks (mean 1.3 times/day, mean 23.2 min/day). All patients had decreased mean PAGI-SYM scores and increased NDI QOL scores, better in the VR group. Seventeen patients reported non-serious AEs (headache, dizziness). One patient withdrew from the study due to migraine. This study suggests that VR may be an effective treatment option for functional dyspepsia. Extensive validation studies are needed.

American Journal of GastroenterologyLogic 117(10S):p e365, October 2022.DOI: 10.14309/01.ajg.0000858696.28989.d8

S1585/Oral 9 – Combined surgical pyloroplasty and gastric electrical stimulation is superior to pyloroplasty alone in patients with gastroparesis: a randomized, double-blind, placebo-controlled trial

Irene Sarosiek, MD· Ryan Torelli· Mohammad Bashashati, MD· Jesus Diaz, MD· Oswald Padilla, MD· Bright Thames, MD· E. Elhanafi, MD· Brian Day Weiss, MD· Richard W. McCallum, MD

sarosik,and others.Presents the results of a randomized, double-blind, placebo-controlled trial evaluating surgical pyloroplasty (SP) and gastric electrical stimulation (GES) versus pyloroplasty (PP) alone for the treatment of gastroparesis. Thirty patients with drug-resistant gastroparesis underwent simultaneous surgical implantation of the GES and PP system. Patients were randomly divided into an active GES stimulation group and a no-stimulation group for 3 months. Gastroparesis Core Symptom Index (GCSI) scores improved in both cohorts compared to baseline at 3 months (p<0.01), but the mean improvement was significantly better in the GES-on group than in the GES-off. All patients started GES at months 3–6 and GCSI improved significantly in the GES off group. There were significantly fewer hospitalizations for vomiting in the GES-ON group compared to the GES-OFF group (p=0.02). Interestingly, no technical difficulties or postoperative complications were reported.

American Journal of Gastroenterology117(10S): p e1131, October 2022.DOI:10.14309/01.ajg.0000862980.76605.08

colon

S133/Oral 63 – An open-label study (ECOSPOR IV) to evaluate the safety, efficacy and tolerability of SER-109, an investigational oral microbiome treatment in patients with adult-onset relapsing-remittingClostridium difficileinfection (rCDI)

Sahil Khanna, MBBS, MS, FACG· Paul Feuerstadt, MD, FACG· Edward Huang, MD, MPH· Katerina Oneto, MD· Darrell S. Pardi, MD, MS, FACG· E. Wang, MD· Ananya De, MD· Kelly Brady, MD, Asli Memisoglu, PhD, David Lombardi, MD, Sarah von Moltke, MD

do,and others.A Phase 3, open-label, single-arm study evaluating the use of SER-109, a purified Firmicutes spore to study the microbiome, in recurrentClostridium difficileinfection (rCDI). 263 patients were enrolled in 2 cohorts: 29 patients with rCDI (cohort 1) from the ECOSPOR III study and 234 patients with >1 CDI recurrence. Patients were treated with standard care antibiotics, followed by SER-109 4 capsules once daily x 3 days. Safety and efficacy were assessed at 8 weeks and duration of response was assessed at 24 weeks. SER-109 was well tolerated. The incidence of rCDI after SER-109 was low (8.7% at week 8 and 13.7% at week 24) regardless of the number of previous CDI episodes.

American Journal of Gastroenterology117(10S): p e96-e97, October 2022.DOI:10.14309/01.ajg.0000857172.24140.48

S164 / Poster A0089 – Naloxegol Provides a Clinically Significant Improvement in Healthcare-Associated Quality of Life (HR-QoL) (PAC-QOL) in Patients with Opioid-Induced Constipation (OIC): A Pooled Analysis of Two Global Phase 3 Studies for Naloxegol

Darren M. Brenner, MD, FACG, Carol Rockett, PharmD, Mansi Jamindar, PharmD, Enoch Borty, June Almenoff, MD, Ph.D., Brooks D. Cash, MD, FACG

Brenner,and others.The results of a pooled analysis of 2 global phase 2 studies of naloxoxicam in the treatment of opioid-induced constipation (OIC) are presented. 1337 patients received naloxegol 25 mg, naloxegol 12.5 mg or placebo. Naloxegol was superior to placebo in achieving clinically significant improvement in symptoms at two thresholds (minimum clinically significant difference thresholds of 0.5 and 0.8). Improvements were dose-dependent, with the highest improvements seen in the 25 mg naloxegol cohort.

American Journal of Gastroenterology117(10S): p e117-e118, October 2022.DOI:10.14309/01.ajg.0000857296.33937.6e

Innovations in Endoscopy

General Endoscopy

S589/Oral 36 – A one-liter polyethylene glycol + ascorbic acid bowel preparation provides high levels of adequate and high-quality bowel cleansing for colonoscopy: a real-world, multicenter observational study with more than 13,000 patients

Catia Arieira, MD· Joseph Cotter, MD· Richard Canyon, MD· Vincent Lawrence-Zuniga, MD· Michael A. Pantaleon Sanchez, MD· Fernando Saturday, MD· Elena Perez Arellano, MD· Blas J. Gomez Rodriguez, MD· Antonio Lopez Cano, MD, Salvador Machlab, MD, Elena Velasco, MD, Sarbelio Rodriguez, MD, Juha Halonen, PhD, Fatma Akriche, MD, Carmen Turby Disla, MD

Ariella,and others.A multicenter observational study of more than 13,000 patients evaluating the use of 1L polyethylene glycol + ascorbic acid (1L PEG + ASC) in bowel preparation for colonoscopy is presented. Patients completed bowel preparation with 1L PEG + ASC as a divided dose or same-day regimen. Adequate bowel preparation, defined as Boston Overall Bowel Preparation Scale (BBPS) >6 with all subgrades >2, was achieved in 89.3% of patients. High-quality debridement, defined as a BBPS segmental score of 3, was achieved in 49.3% of patients. The divided-dose regimen was superior to same-day dosing for adequate preparation (94.7% vs. 86.7%, p<0.0001) and high-quality right colon preparation (65.4% vs. 41.4%, p<0.0001). p<0.0001). Colonoscopy was incomplete due to poor bowel preparation in only 0.8% of patients. Adverse events occurred in 2.3% (nausea 1.2%, vomiting 0.8% and abdominal pain 0.2%).

American Journal of Gastroenterology117(10S): p e415-e416, October 2022.DOI:10.14309/01.ajg.0000858996.89487.6e

therapeutic endoscopy

S1077 / Poster E0442 – New guided scope handle reduces dissection time and technique requirements for endoscopic submucosal debridement for novice endoscopists compared with clip and wire traction methods: an in vitro randomized study

Abhishek Agnihotri, MD, Divya Chalikonda, MD, Daniel Scanlon, BA, Anand Kumar, MD, MPH, Alexander Schlachterman, MD

Agni Hotley,and others.The use of the new guided grasper (SGA) was compared with the conventional clamp wire technique (C&L) during ESD performed by novice endoscopists. The authors conducted a prospective, randomized, single-center trial, recruiting 10 novice endoscopists with 1–3 years of experience but no prior ESD experience. Each subject performed two ESD procedures, each on a 25 mm circular lesion in an isolated pig stomach model. Endoscopists were randomly assigned to perform ESD using SGA first, followed by C&L methods, or vice versa. Mean stripping time was shorter using the SGA compared with the C&L technique, regardless of randomization order (5.07+2.19 min vs. 20.07+8.45 min, P<0.001). Rates of muscle injury and perforation were also lower in the SGA group (1 vs. 4 in the C&L technique group). Interestingly, SGA use was associated with significantly lower NASA Task Load Index scores in the domains of mental, physical, and time demands, performance, effort, and frustration. All participants preferred the SGA over the C&L approach. This study suggests that the SGA may be a valuable tool for novice endoscopists performing ESD using a dual-channel therapeutic endoscope, improving their learning curve through this delicate and demanding procedure and efficiency.

American Journal of Gastroenterology117(10S): p e781, October 2022.DOI:10.14309/01.ajg.0000860948.90894.50

S130 / Oral 34 - Distal capsule-assisted endoscopic mucosal resection is a safe and effective technique for resection of non-protruding or adherent colonic polyps: an international, multicenter, retrospective study

Scott R. Douglas, MD, Douglas K. Rex, MD, MACG, Alessandro Repici, MD, Melissa Kelly, BSN, RN, CGRN, Wes Heinle, MPH, Matthew T. Moyer, MD, MS

Douglas,and others.A multicenter, international, retrospective study was conducted to demonstrate the safety and efficacy of endoscopic mucosal resection (EMR-DC) in the treatment of adherent and nonprotruding colonic polyps. The study included 61 cases of EMR-DC non-protruding colonic polyps due to submucosal fibrosis resulting from previous biopsy, tattooing or attempted resection, performed by three specialist endoscopists. Before EMR-DC, polypectomy or EMR was attempted in 88.5% of patients, submucosal tattoo injection in 1.6%, biopsy in 4.9%, and biopsy and tattoo in 4.9%. Complete macroscopic resection was achieved in 100% of EMR-DCs. Lesion size ranged from 15 mm to 95 mm (mean: 49 mm). Average operating time was 49.5 minutes. At 6 months of follow-up, the adenoma recurrence rate in these complex and adherent lesions was only 9.8%. Two serious postoperative adverse events occurred (3.3%): one postoperative bleeding requiring repeat colonoscopy and one postpolypectomy syndrome requiring hospitalization. This large, multicenter series demonstrated that EMR-DC is a safe and effective approach to treat a difficult and common clinical problem—adherent and nonprotruding polyps.

American Journal of Gastroenterology117(10S): p e94-e96, October 2022.DOI:10.14309/01.ajg.0000857160.20906.1f

Bile duct/pancreas

S83 / Poster D0020 – Fully Covered vs. Uncovered Self-Expanding Metal Stents for Distant Malignant Biliary Obstruction in Locally Advanced Pancreatic Cancer

Jad AbiMansour, MD· Rabih Ghazi, MD· Andrew C. Storm, MD· Michael J. Levy, MD· John A. Martin, MD· MS· Barham Abu Dayyeh, MD, MPH· Bret T. Petersen, MD· Vinay Chandrasekhara , MD

Abi Mansour,and others.A retrospective study was performed comparing fully covered (FC-SEMS) and uncovered (UC-SEMS) self-expanding metal stents [WallFlex (Boston Scientific, Boston, MA) and Flexxus (ConMed, Utica, NY)] in the management of malignant biliary obstruction in local advanced pancreatic cancer. Most in this cohort had UC-SEMS implanted [152 (81.3%)] and had a mean follow-up of 15.6 months (range: 8.8 – 24.6). FC-SEMS was applied to 35 patients (18.7%) followed for a mean of 22.4 months (range: 8.3 – 27.9). Primary outcomes were (1) clinical success defined as 33% reduction in bilirubin within 1 week and 50% within 2 weeks or resolution of obstruction, (2) adverse events (AEs), and (3) need for unplanned reintervention for the management of stent-related AEs. Both stents achieved a significantly high clinical success rate (92.1% UCSEMS vs 97.1% FCSEMS, p = 0.29). Regarding AEs, the higher rate of stent occlusion due to tumor growth in UC-SEMS [(44 (28.9%) vs. 1 (2.9%), p = 0.001)] justified the longer patency time of FC-SEMS. Rates of other AEs did not differ: post-ERCP pancreatitis, stent displacement, and cholecystitis. The rate of unplanned interventions was significantly lower with FC-SEMS compared with UC-SEMS [2 (6%) vs. 44 (29%), p <0.05]. Surgical resection rates, time to stent occlusion, time to unplanned reoperation, survival, and mortality did not differ between the two groups. Despite the retrospective design and the small number of patients in the FC-SEMS group, this study suggests that the use of FC-SEMS reduces reoperation and potentially reduces costs and improves palliative care in patients with distal biliary obstruction due to colon cancer. pancreas.

American Journal of Gastroenterology117(10S): p e61-e62, October 2022.DOI:10.14309/01.ajg.0000856972.84000.5a

S80 / Poster D0003 – Safety of cholangoscopy with telescopes^{TM value}In patients with primary sclerosing cholangitis

Muhammad Salman Faisal, MD1, Mauricio Columbus-Morales, MD1, Omar Shamaa, MD2, Cyrus Piraka, MD1, Andrew Watson, MD1, Robert Pompa, MD1, Duyen Dang, MD1, Tobias Zuchelli, MD1, Sumit Singla, MD2

Faisal,and others.A retrospective study was conducted to evaluate the safety of cholangioscopy in patients with PSC. Eighty-nine patients were included, of whom 28 underwent ERCP and cholangioscopy and 61 underwent ERCP alone. There were no demographic differences between the two groups, including the number of patients with cirrhosis and cholangiocarcinoma. Similarly, the two groups were comparable in terms of ERCP results, interventions, and complications. Interestingly, the incidence of infection or cholangitis was higher in hospitalized patients receiving ERCP alone [7 (11.5%)] compared with ERCP and cholangioscopy [1 (5%)], but this did not reach statistical significance (p = 0.67). As expected, the median total procedure time was longer in the ERCP and cholangioscopy group (90 minutes vs. 70 minutes with ERCP alone); the failure to reach statistical significance may be due to the small sample size. The use of cholangioscopy did not affect the median fluoroscopy time (10.4 vs 11.5 minutes with ERCP alone, p = 0.59). This study suggests that ERCP combined with cholangioscopy is safe in patients with PSC, but larger prospective studies are needed.

American Journal of Gastroenterology117(10S): p e59-e60, October 2022.DOI:10.14309/01.ajg.0000856960.18186.42

S46 / Poster E0013 – EUS-guided needle biopsy versus fine-needle aspiration for pancreatic cystic lesions: a systematic review and meta-analysis

Wasef Sayeh, MD Azizullah A. Beran, MD Sami Ghazaleh, MD Mohammad Safi, MD David Farrow, MD Sudheer Dhoop, MD Rami Musallam, MD Saif-Eddin Malhas, MD Waleed Khokher, MD Omar Sajdeya, MD, Anas Renno, MD;

Legon,and others.A systematic review and meta-analysis of studies comparing ultrasound-guided endoscopic fine-needle aspiration (EUS) with EUS-by-needle biopsy (TTNB) was conducted to obtain adequate sampling and diagnostic accuracy. Nine observational studies involving 520 patients were included. The sample adequacy rate was significantly higher in the EUS-TTNB group than in the EUS-FNA group (RR 1.64, 95% CI 1.19-2.26, p = 0.003, I²= 95%). Only four studies compared the accuracy between the EUS-TTNB method and the EUS-FNA group. Diagnostic accuracy was significantly higher in the EUS-TTNB group than in the EUS-FNA group (RR 2.03, 95% CI 1.13-3.65, p = 0.02, I²= 87%). The authors concluded that, where clinically applicable, EUS-TTNB should be considered to improve diagnostic yield in patients undergoing PCL evaluation.

American Journal of Gastroenterology117(10S): p e34-e35, October 2022.DOI:10.14309/01.ajg.0000856824.07133.76

S1 / Oral Exam 4 - Pancreatic Cancer Screening in High-Risk Populations (Pancreatic Scan Study) Registry Results: A Prospective Multicenter Study

Ishani Shah, MD, Andy Silva-Santisteban, MD, Katharine A. Germansky, MD, Rishi Pawa, MBBS, Vladimir Kushnir, MD, Arvind Trindade, MD, Γιάννης Αναστασίου, MD, Ph.D., Girish Mishra, MD, Sumant Inamdar, MD, Benjamin Tarian, MD, Mandeep S. Sawhney, MD

Shah,and others.It presents the results of a prospective multicenter study (Pancreas Scan Study) in 252 high-risk patients screened for pancreatic cancer. Patients underwent EUS (n=208) or MRI (n=44). High risk pathology was found in 0.8% of patients, intermediate risk in 31.7% and low risk in 23.4% of patients. Two patients were diagnosed with pancreatic cancer (T2N1M0, who received neoadjuvant chemotherapy and pancreatectomy; T2N1M1, who received palliative chemotherapy). There were no adverse effects. Further long-term data are needed to assess the performance and outcomes of pancreatic cancer screening.

American Journal of Gastroenterology117(10S): p e1, October 2022.DOI:10.14309/01.ajg.0000856644.27737.00

S17/E0009 – Biliary tree drainage stent versus radiofrequency ablation with stent alone in patients with malignant biliary strictures: a systematic review and meta-analysis

Omar Hayat, MBBS Cyrus Munguti, MD Muhammad Kamal, MD Muhammad Haseeb, MD, MS

Hayat,and others.A systematic review and meta-analysis of 13 studies (1339 patients) of radiofrequency ablation (RFA) + stenting versus stenting alone for malignant biliary strictures was performed. Stent patency time was longer in the RFA+ stent group, with a pooled weighted mean difference in stent patency time of 43.5 days. Overall survival also favored the RFA + stent group, with a pooled weighted mean difference of 90.53 days. There was no significant difference in the incidence of adverse events between the two groups.

American Journal of Gastroenterology117(10S): p e14-e15, October 2022.DOI:10.14309/01.ajg.0000856708.31470.07

New Technology and Care Pathways

Clinical Applications of Artificial Intelligence

S25 / Poster D0023 – Deep Learning for Automatic Identification of Neoplastic Bile Nodules in Patients with Biliary Stenosis During Digital Cholangoscopy

Tiago Ribeiro, MD· Miguel Mascarenhas, MD· Joao Afonso, MD· Filipe Vilas-Boas· Joao Ferreira, MD·

Ribeiro,and others.To investigate the use of artificial intelligence (AI) in the evaluation of neoplastic biliary nodules in patients with unspecified biliary strictures. The authors designed a convolutional neural network to automatically identify biliary nodules based on 16,150 data frames extracted from 85 patients undergoing cholangioscopy. The framework was classified by two experienced endoscopists, two datasets were created for training and validation, and the network structure was optimized for the detection of malignant biliary nodules. The software achieved encouraging results with 94% sensitivity, 99.9% specificity, 98.8% PPV, 99.7% NPV, and 99.6% overall accuracy. In patients with unexplained biliary strictures, AI-assisted cholangioscopy may help improve the success rate of intraductal biopsy, potentially speeding the diagnosis and management of associated biliary strictures. Further studies incorporating cholangioscopic and histological findings are needed to validate this model.

American Journal of Gastroenterology117(10S): p e20, October 2022.DOI:10.14309/01.ajg.0000856740.48694.91

S1180 / Oral 70 – Portal Venous Doppler with or without AFP Assessed with Artificial Intelligence Can Identify Hepatocellular Carcinoma

Jose D. Debes, MD, PhD, David Jonason, MD, Tiancong Cheng, BS, Ju Sun, PhD

you must,and others.A retrospective review of 142 abdominal ultrasound examinations was presented to assess whether sonographic evaluation of the portal vein was useful in detecting HCC. AI was used to identify Doppler features consistent with HCC. The AI is trained on 80% of the samples and tested on 20% of the samples. The test samples found those Doppler signals that predicted the presence of tumors. Median-sized tumors were relatively small (2.8 cm), with an AUROC of 0.85 at 20 ng/mL. When combined with AFP, the AUROC increased to 0.96. While further validation is needed, the data suggest that AI for audio analysis may help improve cancer detection rates.

American Journal of Gastroenterology117(10S): p e859, October 2022.DOI:10.14309/01.ajg.0000861360.44966.6d

S136 / Poster B0105 – Real-world validation of an AI characterization support system for histologic prediction of polyps at colonoscopy: Interim analysis of a prospective multicenter study

Weiquan James Li, MBBS, MMed· Clement Wu, MBBS, MRCP· Christopher Jen Locke. Hall, MBBS, Raymond, FH. Liang, MBBS, MRCP, Jonathan Wei Jie Lee, MBBS, MRCP, Jimmy So, MBChB, FRCSEd, FRCSG, FAMS, MPH, Weida Chew, MBBS, MRCP

plum,Wait. An interim analysis of a prospective multicenter study evaluating the use of AI for the histological characterization of colonic polyps is presented. 625 polyps (303 hyperplastic, 322 neoplastic) were detected in 257 patients. CADx (Fujifilm Corporation, Tokyo) had a sensitivity of 84.2% for the diagnosis of hyperplastic polyps, compared with 77.6% for CADx and endoscopes. Similar performance was observed in the assessment of small polyps (81.7% vs. 76.3%). This study suggests that CADx may outperform endoscopists in predicting hyperplastic polyp histology during endoscopy. Large prospective studies are needed for further evaluation.

American Journal of Gastroenterology117(10S): p e99, October 2022.DOI:10.14309/01.ajg.0000857184.76822.9c

S134/Oral 57 – Artificial intelligence and high-resolution endoscopy: Automatic detection of rectal squamous cell carcinoma precursors using convolutional neural networks

Miguel Mascarenhas, MD, Lucas Spindler, MD, Nadia Fathallah, MD, Tiago Ribeiro, MD, Joao Afonso, MD, PhD

masqueradesand others.An artificial intelligence system was developed to automatically detect and differentiate high-grade versus low-grade squamous intraepithelial rectal lesions on high-resolution endoscopy (HRA) images. The system was developed using 5026 images (1517 images containing HSIL and 3509 LSIL) from 78 HRA exams completed between January 2021 and January 2022. The test set contains 10% of the images. The overall accuracy of the system was 92.3%. The sensitivity, specificity, positive and negative predictive value of CNN were 91.4%, 92.7%, 86.9% and 95.9%, respectively. The area under the curve is 0.97. This study demonstrates the successful development of an algorithm for the automated classification and detection of rectal squamous cell carcinoma precursor cells with excellent performance and near-perfect AUC. If validated externally, this tool has the potential to facilitate early diagnosis and treatment, potentially bypassing histopathological diagnosis.

American Journal of Gastroenterology117(10S): p e97-e98, October 2022.DOI:10.14309/01.ajg.0000857176.10120.1e

Artificial Intelligence in Healthcare Operations/Practical Management:

S307 / Poster A0177 – Artificial intelligence to identify high-risk patients lost to follow-up for colorectal cancer screening during the COVID-19 pandemic

Joseph D. Feuerstein, MD, Samuel Miller, MD, Michelle Ladonne, MHA, CMPE, Arvind Ravi, MD, PhD

flint,and others.Describes the use of an artificial intelligence system to identify high-risk patients who may be delayed for repeat colonoscopy during the COVID-19 pandemic and to investigate the reasons for loss to follow-up over a 2-year period. A natural language (NLP) tool was developed to convert procedural reports into text files, which the researchers evaluated alongside electronic health care records (EHRs) to determine if and when they should monitor the process. Of the 677 cases recommended for follow-up within 2 years, 24% (n=162) were flagged as potentially overdue. Of the 162 cases, 48 colonoscopy orders were missed, 31 were not contacted through arrangements, and 32 were lost to follow-up despite at least 1 outreach attempt. The remaining 51 were also lost to follow-up but were not considered overdue (colonoscopy elsewhere, deceased, etc.). This study focuses on the use of NLP to automatically identify patients overdue for colonoscopy for various reasons. Such a system has the potential to flag these cases, allowing opportunities for intervention and optimization of surveillance compliance in patients at risk for colorectal cancer.

American Journal of Gastroenterology117(10S): p e221, October 2022.DOI:10.14309/01.ajg.0000857868.62929.a2

S285 / Poster E0173 – Validation of a deep machine learning tool to identify quality indicators for colonoscopy during the screening process in academic health systems

Artin Galoosian, MD, MA· Jamie O. Yang, MD· Emma Peterson, MS· Cleo K. Maehara, MD, MMSC· Jayran Badie, MPH· Camille Soroud, MD· Anthony Myint· Yuna Kang, MD· Bita V. Nine , MD, Sadie De Silva, MD, V. Raman Muthusamy, MD, MAS, FACG, Eric Israel, MD, MPH, Folasade P. May, MD, PhD, MPhil

Galusia,and others.A natural language processing (NLP) tool was developed and validated to automatically measure 4 in-procedure colonoscopy quality improvement (QI) metrics: colonoscopy indication (IND), bowel preparation (BP), cecal intubation (CI), and successful colonoscopy ( SCI) . They compared the performance of NLP to automatically classify these variables with that of a human, the gold standard chart review. For all measurements, the sensitivity of the NLP system ranged from 99.3 to 100.0%, and the specificity ranged from 94.3 to 100.0%. NLP misclassified 15 cases (2 IND, 1 BP and 12 SCI) compared to humans. These were mainly due to conflicting endoscopy records in the endoscopy reports. This study investigates the automated collection of colonoscopy quality metrics using NLP. The advantage of an automated NLP system is that it can collect a large amount of high-quality data in a short period of time, saving hours of human work. However, further improvements to the pipeline, including more accurate documentation by endoscopists and further improvements to the NLP tools, are needed before this tool can be implemented.

American Journal of Gastroenterology117(10S): p e204-e205, October 2022.DOI:10.14309/01.ajg.0000857780.82735.33