Effect of AI on Performance of Endoscopists to Detect Barrett Neoplasia: A Randomized Tandem Trial

Michael Meinikheim,Robert Mendel，Helmut Messmann,Alanna Ebigbo

Endoscopy（2024）

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Abstract

Background and study aims To evaluate the effect of an AI-based clinical decision support system (AI) on the performance and diagnostic confidence of endoscopists during the assessment of Barrett's esophagus (BE). Patients and Methods Ninety-six standardized endoscopy videos were assessed by 22 endoscopists from 12 different centers with varying degrees of BE experience. The assessment was randomized into two video sets: Group A (review first without AI and second with AI) and group B (review first with AI and second without AI). Endoscopists were required to evaluate each video for the presence of Barrett's esophagus-related neoplasia (BERN) and then decide on a spot for a targeted biopsy. After the second assessment, they were allowed to change their clinical decision and confidence level. Results AI had a standalone sensitivity, specificity, and accuracy of 92.2%, 68.9%, and 81.6%, respectively. Without AI, BE experts had an overall sensitivity, specificity, and accuracy of 83.3%, 58.1 and 71.5%, respectively. With AI, BE nonexperts showed a significant improvement in sensitivity and specificity when videos were assessed a second time with AI (sensitivity 69.7% (95% CI, 65.2% - 74.2%) to 78.0% (95% CI, 74.0% - 82.0%); specificity 67.3% (95% CI, 62.5% - 72.2%) to 72.7% (95 CI, 68.2% - 77.3%). In addition, the diagnostic confidence of BE nonexperts improved significantly with AI. Conclusion BE nonexperts benefitted significantly from the additional AI. BE experts and nonexperts remained below the standalone performance of AI, suggesting that there may be other factors influencing endoscopists to follow or discard AI advice.

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【要点】：本研究评估了基于人工智能的临床决策支持系统对内镜医师在评估巴雷特食管相关肿瘤时的表现和诊断信心的影响，发现非专家内镜医师在AI辅助下诊断准确性显著提高。

【方法】：通过随机双盲试验，将96个标准化的内镜视频分为两组，一组先不使用AI辅助，后使用AI辅助评估；另一组先使用AI辅助，后不使用AI辅助评估。

【实验】：22名内镜医师（来自12个不同中心，经验水平不等）参与实验，使用的数据集为96个标准化内镜视频。结果显示，AI独立诊断的敏感性、特异性和准确性分别为92.2%、68.9%和81.6%；非专家内镜医师在AI辅助下第二次评估时敏感性从69.7%提高到78.0%，特异性从67.3%提高到72.7%，诊断信心也显著提高。

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