A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program

International audienceIntroduction and study aims Accurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool.Methods A prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3 – 6 months, a last test (T3 M) was performed, including these same still frames and 20 new ones.Results A total 419 participants followed the teaching program between April 2017 and April 2018. The mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3 M, from 51.0 % to 74.0 % and to 66.6 % respectively (P < 0.001). Between pretest and post-test, 343 (86.6 %) trainees improved, and 153 (75.4 %) at T3 M. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1 % to 15.5 % at post-test and to 18.5 % at T3 M (P < 0.001).Conclusion The CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp

Long-Term Results of Endoscopic Metal Stenting for Biliary Anastomotic Stricture after Liver Transplantation

(1) Background: Anastomotic biliary stricture (ABS) is a well-known complication of liver transplantation which can lead to secondary biliary cirrhosis and graft dysfunction. The goal of this study was to evaluate the long-term outcomes of endoscopic metal stenting of ABS in the setting of deceased donor liver transplantation (DDLT). (2) Methods: Consecutive DDLT patients with endoscopic metal stenting for ABS between 2010 and 2015 were screened. Data on diagnosis, treatment and follow-up (until June 2022) were collected. The primary outcome was endoscopic treatment failure defined as the need for surgical refection. (3) Results: Among the 465 patients who underwent LT, 41 developed ABS. It was diagnosed after a mean period of 7.4 months (+/&minus;10.6) following LT. Endoscopic treatment was technically successful in 95.1% of cases. The mean duration of endoscopic treatment was 12.8 months (+/&minus;9.1) and 53.7% of patients completed a 1-year treatment. After a mean follow-up of 6.9 years (+/&minus;2.3), endoscopic treatment failed in nine patients (22%) who required surgical refection. Conclusions: Endoscopic management with metal stenting of ABS after DDLT was technically successful in most cases, and half of the patients had at least one year of indwelling stent. Endoscopic treatment long-term failure rate occurred in one fifth of the patients

Intelligence artificielle et endoscopie : le meilleur des mondes ?

National audienceL’intelligence artificielle (IA) a pour objet de simuler l’intelligence humaine. Il s’agit d’une science cognitive qui fait appel à la neurobiologie et à la logique (résolution des problèmes, apprentissage profond, réseaux neuronaux), à l’informatique (puissance de calculs des ordinateurs, internet), et qui se nourrit de bases de données. Elle trouve ses premières applications en santé – et ses premières autorisations de mise sur le marché – dans l’exploitation des mégadonnées (épidémiologie, médecine prédictive) et dans l’analyse des signaux (tracés ECG et EEG, imagerie médicale, anatomopathologie, dermatologie, ophtalmologie…). Leur champ d’application en endoscopie digestive est également très vaste, englobant le dépistage, le diagnostic, la caractérisation, la thérapeutique, le pronostic, et cela pour tout type d’intervention. Le nombre de publications dans ce domaine augmente de façon exponentielle. Les premières réalisations concernant la détection et la caractérisation de polypes coliques assistées par ordinateur devraient faire prochainement l’objet d’une industrialisation. La pré-lecture de vidéocapsules endoscopiques par des systèmes d’apprentissage profond, en réseau, est également un modèle très illustratif du développement de l’IA en endoscopie. Cette révolution technologique est susceptible d’améliorer les performances des médecins et donc la qualité des soins. Elle mérite d’être accompagnée par les endoscopistes, non seulement concernant ses aspects techniques et cliniques, mais également pour répondre aux nouvelles questions qui en découlent, notamment sur les places relatives du médecin (moins technicien, plus humain ?) et de la machine (assistante ou autonome ?), sur la responsabilité médicale (homme ou machine ?), sur le remboursement des actes (médecin ou prestataire ?)

Instruments Segmentation in X-ray Fluoroscopic Images for Endoscopic Retrograde Cholangio Pancreatography

International audienceIn this work, we propose a method to segment endoscope and guidewire from 2D X-ray fluoroscopic images of an endoscopic retrograde cholangiopancreatography (ERCP). We used an improved U-Net model. We obtained a Dice score of 0.94±0.05 for endoscope segmentation and a Hausdorff distance of 24.26 pixels for the guidewire segmentation. These preliminary results pave the way for further applications aiming at aiding the medical procedure

Multi-criterion, automated, high-performance, rapid tool for assessing mucosal visualization quality of still images in small bowel capsule endoscopy

International audienc

Development and Validation of a Highly Sensitive and Highly Specific Computed Assessment of Cleansing Score for Small Bowel Capsule Endoscopy

International audienc

Development and Validation of a Computed Assessment of Cleansing Score For Evaluation of the Quality of Small-bowel Visualization in Capsule Endoscopy

International audienc