Impact of Artificial Intelligence on Miss Rate of Colorectal Neoplasia.

BACKGROUND & AIMS: Artificial intelligence (AI) may detect colorectal polyps that have been missed due to perceptual pitfalls. By reducing such miss rate, AI may increase the detection of colorectal neoplasia leading to a higher degree of colorectal cancer (CRC) prevention. METHODS: Patients undergoing CRC screening or surveillance were enrolled in 8 centers (Italy, UK, US), and randomized (1:1) to undergo 2 same-day, back-to-back colonoscopies with or without AI (deep learning computer aided diagnosis endoscopy) in 2 different arms, namely AI followed by colonoscopy without AI or vice-versa. Adenoma miss rate (AMR) was calculated as the number of histologically verified lesions detected at second colonoscopy divided by the total number of lesions detected at first and second colonoscopy. Mean number of lesions detected in the second colonoscopy and proportion of false negative subjects (no lesion at first colonoscopy and at least 1 at second) were calculated. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted by endoscopist, age, sex, and indication for colonoscopy. Adverse events were also measured. RESULTS: A total of 230 subjects (116 AI first, 114 standard colonoscopy first) were included in the study analysis. AMR was 15.5% (38 of 246) and 32.4% (80 of 247) in the arm with AI and non-AI colonoscopy first, respectively (adjusted OR, 0.38; 95% CI, 0.23-0.62). In detail, AMR was lower for AI first for the ≤5 mm (15.9% vs 35.8%; OR, 0.34; 95% CI, 0.21-0.55) and nonpolypoid lesions (16.8% vs 45.8%; OR, 0.24; 95% CI, 0.13-0.43), and it was lower both in the proximal (18.3% vs 32.5%; OR, 0.46; 95% CI, 0.26-0.78) and distal colon (10.8% vs 32.1%; OR, 0.25; 95% CI, 0.11-0.57). Mean number of adenomas at second colonoscopy was lower in the AI-first group as compared with non-AI colonoscopy first (0.33 ± 0.63 vs 0.70 ± 0.97, P < .001). False negative rates were 6.8% (3 of 44 patients) and 29.6% (13 of 44) in the AI and non-AI first arms, respectively (OR, 0.17; 95% CI, 0.05-0.67). No difference in the rate of adverse events was found between the 2 groups. CONCLUSIONS: AI resulted in an approximately 2-fold reduction in miss rate of colorectal neoplasia, supporting AI-benefit in reducing perceptual errors for small and subtle lesions at standard colonoscopy. CLINICALTRIALS: gov, Number: NCT03954548.

Pediatric hospitalizations for inflammatory bowel disease based on annual case volume: results from the Kids' Inpatient Database 2012.

To study differences related to pediatric inflammatory bowel disease (IBD) care among hospitals that were stratified based on annual case volume. This is a cross-sectional study using data from the United States Healthcare Cost and Utilization Project Kids' Inpatient Database (KID). IBD-related hospitalizations were identified using International Classification of Diseases-9-Clinical Modification codes. Hospital volume was divided into low or high by assigning cut-off values of 1-20 and >20 annual IBD hospitalizations. We assessed a total of 8647 pediatric IBD discharges during 2012 from 660 hospitals in the USA. 107 of these hospitals were classified as high-volume centers (HVCs) for pediatric IBD care and 553 low-volume centers (LVCs). HVCs were more likely to be associated with an academic teaching status compared to LVCs (97.1% vs 67.6%, p<0.001). The incidence of transfer of medical care from LVCs to other hospitals was 5.5% but only 0.7% for HVCs (p<0.001). The median number of procedures (medical and surgical) performed on children admitted with IBD was higher at HVCs (2 vs 1, p<0.001). IBD admissions at HVCs were more likely to undergo surgical procedures compared to LVCs (17% vs 10%, p<0.001). The incidence of postoperative complications was not significantly different. There were significantly greater hospital costs (median US$11,000 vs US$6,000, p<0.001) and lengths of stay (median 5 days vs 4 days, p<0.001) associated with HVCs compared to LVCs. Pediatric admissions to HVCs for IBD undergo a greater number of medical and surgical procedures and are associated with higher costs and lengthier hospital stays.

Role of intestinal bacteria in the pathogenesis of pouchitis.

Pouchitis is a common complication seen in patients with ulcerative colitis who undergo total proctocolectomy with ileal pouch anal anastomosis. Bacteria seem to play an important role in the development of pouchitis, although this role is not well defined. Because technology has advanced, we are able to apply molecular techniques to describe the structure and function of the pouch microbial community. In recent years, several studies have been performed comparing the pouch microbiota in patients with ulcerative colitis with healthy pouches and pouchitis. Many of these studies have suggested that pouchitis is characterized by dysbiosis and/or decreased microbial diversity. There has not been a clear pattern identifying a pathogenic organism or a group of organisms responsible for pouchitis. This review summarizes recent studies exploring the pouch microbiota in health and disease, the relationship of bacterial metabolites and pouchitis, and the role of antibiotics and probiotics for the treatment and prevention of pouchitis.