Diagnostic accuracy of a novel artificial intelligence system for adenoma detection in daily practice: a prospective nonrandomized comparative study.

BACKGROUND: Adenoma detection rate (ADR) varies significantly between endoscopists, with adenoma miss rates (AMRs) up to 26 %. Artificial intelligence (AI) systems may improve endoscopy quality and reduce the rate of interval cancer. We evaluated the efficacy of an AI system in real-time colonoscopy and its influence on AMR and ADR. METHODS: This prospective, nonrandomized, comparative study analyzed patients undergoing diagnostic colonoscopy at a single endoscopy center in Germany from June to October 2020. Every patient was examined concurrently by an endoscopist and AI using two opposing screens. The AI system, overseen by a second observer, was not visible to the endoscopist. AMR was the primary outcome. Both methods were compared using McNemar test. RESULTS: 150 patients were included (mean age 65 years [standard deviation 14]; 69 women). There was no significant or clinically relevant difference (P = 0.75) in AMR between the AI system (6/197, 3.0 %; 95 % confidence interval [CI] 1.1-6.5) and routine colonoscopy (4/197, 2.0 %; 95 %CI 0.6-5.1). The polyp miss rate of the AI system (14/311, 4.5 %; 95 %CI 2.5-7.4) was not significantly different (P = 0.72) from routine colonoscopy (17/311, 5.5 %; 95 %CI 3.2-8.6). There was no significant difference (P = 0.50) in ADR between routine colonoscopy (78/150, 52.0 %; 95 %CI 43.7-60.2) and the AI system (76/150, 50.7 %; 95 %CI 42.4-58.9). Routine colonoscopy detected adenomas in two patients that were missed by the AI system. CONCLUSION: The AI system performance was comparable to that of experienced endoscopists during real-time colonoscopy with similar high ADR (> 50 %).

Flucloxacillin-induced immune thrombocytopenia.

BACKGROUND: Drug-induced immune thrombocytopenia (DITP) is an adverse drug reaction associated with platelet (PLT) destruction by drug-dependent antibodies. Demonstration of drug-dependent PLT antibodies is often difficult and can only be rendered by extensive laboratory testing. In this report, we present the first serologically confirmed case of DITP caused by the antibiotic flucloxacillin. CASE REPORT: A 68-year-old man developed severe thrombocytopenia that was first suspected to be related to heparin-induced thrombocytopenia. The absence of PLT-activating heparin-dependent antibodies and the abrupt decrease in PLT count to fewer than 20 × 10(9) /L raised the suspicion of DITP. DISCUSSION: Flucloxacillin-dependent antibodies were detected in patient serum using whole PLT enzyme immunoassay and flow cytometry. The glycoprotein (GP) specificity was identified to be against GP IIb/IIIa complexes using the monoclonal antibody immobilization of PLT antigens assay. Interestingly, antibody binding was abolished when EDTA plasma was used and restored after adding calcium. CONCLUSION: In summary, DITP should be considered in cases of acute thrombocytopenia during treatment with flucloxacillin.

Accuracy of polyp characterization by artificial intelligence and endoscopists: a prospective, non-randomized study in a tertiary endoscopy center.

Background and study aims Artificial intelligence (AI) in gastrointestinal endoscopy is developing very fast. Computer-aided detection of polyps and computer-aided diagnosis (CADx) for polyp characterization are available now. This study was performed to evaluate the diagnostic performance of a new commercially available CADx system in clinical practice. Patients and methods This prospective, non-randomized study was performed at a tertiary academic endoscopy center from March to August 2022. We included patients receiving a colonoscopy. Polypectomy had to be performed in all polyps. Every patient was examined concurrently by an endoscopist and AI using two opposing screens. The AI system, overseen by a second observer, was not visible to the endoscopist. The primary outcome was accuracy of the AI classifying the polyps into "neoplastic" and "non-neoplastic." The secondary outcome was accuracy of the classification by the endoscopists. Sessile serrated lesions were classified as neoplastic. Results We included 156 patients (mean age 65; 57 women) with 262 polyps ≤10 mm. Eighty-four were hyperplastic polyps (32.1%), 158 adenomas (60.3%), seven sessile serrated lesions (2.7%) and 13 other entities (normal/inflammatory colonmucosa, lymphoidic polyp) (4.9%) on histological diagnosis. Sensitivity, specificity and accuracy of AI were 89.70% (95% confidence interval [CI]: 84.02%-93.88%), 75.26% (95% CI: 65.46%-83.46%) and 84.35% (95% CI:79.38%-88.53%), respectively. Sensitivity, specificity and accuracy for less experienced endoscopists (2-5 years of endoscopy) were 95.56% (95% CI: 84.85%-99.46%), 61.54% (95% CI: 40.57%-79.77%) and 83.10% (95% CI: 72.34%-90.95%) and for experienced endoscopists 90.83% (95% CI: 84.19%-95.33%), 71.83% (95% CI: 59.90%-81.87%) and 83.77% (95% CI: 77.76%-88.70%), respectively. Conclusion Accuracy for polyp characterization by a new commercially available AI system is high, but does not fulfill the criteria for a "resect-and-discard" strategy.

[39-year-old man with 15 years lasting pain in both hands]. / 39-jähriger Patient mit jahrelangen Schmerzen an beiden Händen.

In the article "39-year-old patient with years of pain in both hands" (Dtsch Med Wochenschr 2015; 140: 1231) have called the names of the authors Klaus Muehlenberg, Claudia Metzler and Oliver Pech.