Role of artificial intelligence-guided esophagogastroduodenoscopy in assessing the procedural completeness and quality.

BACKGROUND AND AIMS: The quality of esophagogastroduodenoscopy (EGD) can have great impact on the detection of esophageal and gastric lesions, including malignancies. The aim of the study is to investigate the use of artificial intelligence (AI) during EGD by the  endoscopists-in-training so that a real-time feedback can be provided, ensuring compliance to a pre-decided protocol for examination. METHODS: This is an observational pilot study. The videos of the EGD procedure performed between August 1, 2021, and September 30, 2021, were prospectively analyzed using AI system. The assessment of completeness of the procedure was done based on the visualizsation of pre-defined 29 locations. Endoscopists were divided into two categories - whether they are in the training period (category A) or have competed their endoscopy training (category B). RESULTS: A total of 277 procedures, which included 114 category-A and 163 category-B endoscopists, respectively, were included. Most commonly covered areas by the endoscopists were greater curvature of antrum (97.47%), second part of duodenum (96.75%), other parts of antrum such as the anterior, lesser curvature and the posterior aspect (96.75%, 94.95%, and 94.22%, respectively). Commonly missed or inadequately seen areas were vocal cords (99.28%), epiglottis (93.14%) and posterior, anterior, and lateral aspect of incisura (78.70%, 73.65%, and 73.53%, respectively). The good quality procedures were done predominantly by categoryB endoscopists (88.68% vs. 11.32%, p < 0.00001). CONCLUSION: AI can play an important role in assessing the quality and completeness of EGD and can be a part of training of endoscopy in future.

Difficult Biliary Cannulation for Intradiverticular Papilla: Forceps Technique Revisited.

Periampullary diverticula (PAD) have been encountered in 5.9 to 18.5% of patients during all the endoscopic retrograde cholangiopancreatography (ERCP). Cannulation in the presence of PAD can sometimes be difficult, time consuming, and often requires a higher level of endoscopic skills. Several techniques have been reported to facilitate and increase the chances of successful bile duct cannulation in the presence of PAD. The two-devices in one-channel method has been sparingly used. It involves the simultaneous use of a biopsy forceps and another instrument, either a cannula or sphincterotome through the same working channel. We successfully performed ERCP in three cases, where bile duct cannulation was performed in the setting of intradiverticular papilla using two-devices in one-channel method. We feel that the two-devices in one-channel method can be very useful and positioned higher up in the algorithm for successful cannulation in patients with PAD.